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Anti-CCP status determines the power Doppler oscillation pattern in rheumatoid arthritis: a prospective study

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Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease leading to joint destruction. Serologically, it can be differentiated according to rheumatoid factor (RF), anti-cyclic citrullinated peptide antibodies (anti-CCP), or both. This differentiation is prognostically and therapeutically relevant. No method has been described to separate the two forms phenotypically. We hypothesize that a differentiation is possible by evaluating oscillation patterns in power Doppler sonography (PDS). In a prospective study, 20 patients with anti-CCP-positive RA and 20 patients with anti-CCP-negative RA with active wrist synovitis were examined. A PDS scan was performed, and perfusion maxima (P max) and minima (P min) as well as the amplitude (ΔP) were determined by a blinded study member. The amplitude was standardized (sΔP) by dividing by P max, and the anti-CCP-positive and anti-CCP-negative patients as well as the RF-positive and RF-negative were compared to each other. In the ultrasonographic evaluation, we found a highly significant difference in sΔP between CCPp and CCPn patients (median 19.0 vs. 42.9 %, p < 0.0001). sΔP is independent of disease activity. The absolute amplitude ΔP did not differ between the groups. Also, in anti-CCP-positive patients there was a completely linear correlation between P max and P min, and this was far less marked in anti-CCP-negative patients. Anti-CCP-positive and anti-CCP-negative RA display different PDS oscillation patterns. This constitutes a nonserological parameter to differentiate between the two forms. The difference in PDS oscillation patterns suggests that the underlying pathological process differs between the forms.

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Funding

No external funding was obtained for performing this study.

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Authors and Affiliations

  1. Department of Rheumatology/Immunology, Medical Clinic II, University Clinic Wuerzburg, Oberduerrbacher Str. 6, 97080, Würzburg, Germany

    Ottar Gadeholt, Sebastian Schuh, Eva Scharbatke, Eva Ostermeier, Hans-Peter Tony & Marc Schmalzing

  2. Department of Experimental Radiology, University Clinic Wuerzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany

    Tobias Wech

Authors
  1. Ottar Gadeholt
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  2. Tobias Wech
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  3. Sebastian Schuh
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  4. Eva Scharbatke
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  5. Eva Ostermeier
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  6. Hans-Peter Tony
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  7. Marc Schmalzing
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Corresponding author

Correspondence to Ottar Gadeholt.

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Conflict of interest

Ottar Gadeholt, Tobias Wech, Sebastian Schuh, Eva Ostermeier, Eva Christina Scharbatke and Marc Schmalzing declare that they have no conflict of interest. Hans-Peter Tony: Consultant/speaker buro: Abbvie, BMS, Chugai, Janssen, Lilly, MSD, Novartis, Roche, Takeda, UCB.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Gadeholt, O., Wech, T., Schuh, S. et al. Anti-CCP status determines the power Doppler oscillation pattern in rheumatoid arthritis: a prospective study. Rheumatol Int 36, 1671–1675 (2016). https://doi.org/10.1007/s00296-016-3548-6

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  • DOI: https://doi.org/10.1007/s00296-016-3548-6

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