Patients with rheumatoid arthritis (RA) with positive anticyclic citrullinated peptide (anti-CCP+) are more likely to experience a major hip fracture and have lower bone mineral density levels compared with patients who have anti-CCP− RA, according to results published in Arthritis Research & Therapy.

The study included 521 patients with RA, 68.9% of whom had anti-CCP+ RA (n=359). The researchers collected information on demographics, disease duration, Disease Activity Score in 28 joints based on erythrocyte sedimentation rate, lifestyle, evidence of previous fracture, risk factors for fracture in the Fracture Risk Assessment Tool (FRAX®), and FRAX® scores. Anti-CCP positivity, rheumatoid factor, erythrocyte sedimentation rate, C-reactive protein level, and bone mineral density were also measured on enrollment in the study.

Patients who had anti-CCP+ RA had significantly higher Disease Activity Score in 28 joints based on erythrocyte sedimentation rate (P =.0001) and 10-year probability of major fracture (15.0 [18.9] vs 12.0 [15.3], P =.0461) or hip fracture (5.0 [9.2] vs 3.6 [8.2], P =.0118) compared with patients who had anti-CCP− RA.


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Patients who had anti-CCP+ RA had significantly lower bone mineral density of the femoral neck (P =.0196) compared with patients who had anti-CCP− RA. The rates of osteoporosis and previous fracture were comparable.

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“Studies designed to explore whether there is a difference in incident fractures between [patients with] anti-CCP+ and anti-CCP− [rheumatoid arthritis] or whether anti-CCP should be incorporated into the updated version of the FRAX® tool for [rheumatoid arthritis] are needed to determine the real impact of our findings,” the researchers wrote.

Reference

Cheng TT, Yu SF, Su FM, et al. Anti-CCP-positive patients with RA have a higher 10-year probability of fracture evaluated by FRAX®: a registry study of RA with osteoporosis/fracture. Arthritis Res Ther. 2018;20:16.