The influence of autoantibody status and characteristics on the course of rheumatoid arthritis

Abstract

The identification of ACPA has been a major breakthrough in the understanding of pathogenesis in RA. It has become clear that this unique autoantibody response identifies more homogenous subsets of patients with RA than those characterized by levels of other autoantibodies, and that differing disease courses possibly reflect the involvement of ACPA in disease pathogenesis. The elucidation of the characteristics of the ACPA response have shown that ACPA are not pathogenic per se, as illustrated by the fact that most patients are ACPA-positive a while before they develop disease. Possibly, a more mature ACPA response__as illustrated by more extensive isotype switching, enhanced antigen-recognition profile and higher titers__might be required for these autoantibodies to contribute to disease pathogenesis. Once RA is established, the ACPA response does not seem to mature. Nonetheless, ACPA status is important for clinical decision making, as it is the factor that is most predictive of disease outcome and associates with the effectiveness of various interventions