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ACPA-positive versus ACPA-negative rheumatoid arthritis: two distinct erosive disease entities on radiography and ultrasonography

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Abstract

The objective of this study is to assess the prevalence, localization, and severity of bone erosions on radiography (RX) and ultrasonography (US) according to ACPA status in patients with rheumatoid arthritis (RA). 78 patients with ACPA-positive (ACPA+) RA and 30 patients with ACPA-negative (ACPA−) RA fulfilling the ACR 1987 and/or ACR/EULAR 2010 criteria were consecutively included. On RX, a modified Sharp erosion score (SHSe) was evaluated by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤ three). On US, erosions were scored on six bilateral joints (MCP2, 3, 5; MTP2, 3, 5) with a four-point scale to calculate the total US score for erosions (USSe). The mean total SHSe and USSe were 3.7 and 4.4 times higher in the ACPA+ group than in the ACPA− group, respectively (P < 0.001). On both RX and US, the most discriminating joint between the two groups was MTP5, especially in cases with bilateral erosion. Based on multivariate analyses, ACPA + status was associated with erosive RA on RX according to the EULAR 2013 definition criteria [OR 4.4 (95% CI 1.2–16.4)], and on US according to the following two definitions: the presence of at least two eroded joint facets [OR 3.7 (95% CI 1.4–9.9)] or at least one grade 2 joint facet erosion [OR 9.0 (95% CI 2.8–28.4)]. Compared to ACPA− RA, ACPA + RA is associated independently with more severe erosive disease on RX and US. Both US and RX bilateral erosions in MTP5 joints are highly discriminant for ACPA + RA patients (97.8% in US and 100% in RX).

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Authors and Affiliations

  1. Department of Rheumatology, University Hospital of Nancy, 54500, Vandoeuvre-lès-Nancy, France

    Julien Grosse, Edem Allado, Camille Roux, Isabelle Chary-Valckenaere & Damien Loeuille

  2. Department of Rheumatology, Academic Hospital Pitié-Salpêtrière, 75013, Paris, France

    Audrey Pierreisnard

  3. Department of Rheumatology, University Hospital of Clermont-Ferrand, 63000, Clermont-Ferrand, France

    Marion Couderc

  4. Platform of Clinical Research Support PARC (MDS Unity), University Hospital of Nancy, 54500, Vandoeuvre-lès-Nancy, France

    Isabelle Clerc-Urmes, Thomas Remen & Éliane Albuisson

  5. Biology and Immunology Laboratory, University Hospital of Nancy, 54500, Vandoeuvre-lès-Nancy, France

    Marcelo De Carvalho-Bittencourt

  6. INSERM, CIC-EC CIE6, Nancy, France University Hospital of Nancy, Epidemiology and Clinical Evaluation, 54500, Vandoeuvre-lès-Nancy, France

    Isabelle Chary-Valckenaere & Damien Loeuille

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  1. Julien Grosse
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Contributions

JG and DL designed the study. AP, MC, and ICV performed the radiography assessment. DL and ICV performed the ultrasound assessment. MDC provided ACPA and RF values. JG and CR collected all of the data. EALL, ICU, TR, and EALB analyzed the data. JG, EALL, and DL aided in interpreting the results. JG wrote the paper with input from all authors. All co-authors approve the final version of the manuscript and take full responsibility for all its aspects.

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Correspondence to Julien Grosse.

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All of the authors declare that they have no conflict of interest.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee [the ethical committee of Nancy approved the study in June 2017 (number: R2017-17)] and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Grosse, J., Allado, E., Roux, C. et al. ACPA-positive versus ACPA-negative rheumatoid arthritis: two distinct erosive disease entities on radiography and ultrasonography. Rheumatol Int 40, 615–624 (2020). https://doi.org/10.1007/s00296-019-04492-5

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