PT  - JOURNAL ARTICLE
AU  - Burgers, Leonie E
AU  - van Steenbergen, Hanna W
AU  - ten Brinck, Robin M
AU  - Huizinga, Tom WJ
AU  - van der Helm-van Mil, Annette HM
TI  - Differences in the symptomatic phase preceding ACPA-positive and ACPA-negative RA: a longitudinal study in arthralgia during progression to clinical arthritis
AID  - 10.1136/annrheumdis-2017-211325
DP  - 2017 Oct 01
TA  - Annals of the Rheumatic Diseases
PG  - 1751--1754
VI  - 76
IP  - 10
4099  - http://ard.bmj.com/content/76/10/1751.short
4100  - http://ard.bmj.com/content/76/10/1751.full
SO  - Ann Rheum Dis2017 Oct 01; 76
AB  - Objective Although anticitrullinated protein antibody (ACPA)-positive and ACPA-negative rheumatoid arthritis (RA) have different aetiopathology, the clinical presentation at the time of diagnosis is similar. This study evaluated whether there are phenotypic differences in the symptomatic pre-RA phase.Methods Patients with arthralgia included in the Leiden clinically suspect arthralgia cohort who developed arthritis during follow-up were studied (n=67). Symptoms at symptom onset, symptoms and signs at presentation with arthralgia and time to arthritis development were compared between ACPA-positive and ACPA-negative patients.Results In ACPA-negative patients (n=37), the location of initial symptoms less often included the lower extremities (22% vs 50%, p=0.014). At presentation with arthralgia, ACPA-positive patients had a longer symptom duration (median 22 vs 14 weeks, p=0.005), less tender joints (mean 5 vs 9, p=0.007) and less difficulty making a fist (11% vs 43%, p=0.004). However, after presentation with arthralgia, ACPA-positive patients developed arthritis more quickly (median 6 vs 18 weeks, p=0.015). A partial least squares regression analysis showed clustering of ACPA-positive and ACPA-negative patients based on the above-mentioned clinical variables.Conclusion This study is the first showing that ACPA-positive and ACPA-negative patients have clinical differences in the symptomatic phase preceding clinical arthritis. This contributes to the notion that ACPA-positive and ACPA-negative RA develop differently.