Baseline RA Autoantibodies May Not Be Associated With Long-Term Outcomes

Investigators analyzed the composition of the autoantibody profile in rheumatoid arthritis and determined whether there is an influence on treatment outcomes.

A broad baseline autoantibody profile in patients with rheumatoid arthritis (RA) is associated with a better early treatment response to medications but not necessarily with long-term outcomes, according to a study published in Arthritis Research & Therapy.

To explore the link between the humoral autoimmune response and clinical outcomes, researchers measured immunoglobulin G (IgG), IgM, and IgA isotypes at baseline and at the moment of drug tapering in 399 seropositive patients with RA. They found that the number of autoantibodies at baseline was independently and dose-dependently associated with a greater decrease in the disease activity score after 4 months of conventional disease-modifying antirheumatic drug therapy. 

However, a broad autoantibody profile at baseline was associated with less probability of achieving drug-free remission during the early stages of drug tapering, but not later in the treatment regimen when long-term sustained drug-free remission was unrelated to the extent of autoimmune response. In addition, the researchers found that reassessing the autoantibody profile at the moment of drug tapering does not provide further information about the likelihood of successfully discontinuing medication.   

The researchers concluded, “This large study shows that seropositive patients with RA with a broader autoantibody profile at baseline initially respond better to treatment and have a slightly worse chance of achieving [drug-free remission] at early stages, but that the magnitude of seropositivity does not affect the ability to taper off medication and remain in remission later in disease.” Thus, a broad autoantibody profile in the early stages of disease may make the underlying disease processes more susceptible to medications, but the importance of this profile for treatment outcomes decreases over time.

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de Moel EC, Derksen VFAM, Stoeken G, et al. Baseline autoantibody profile in rheumatoid arthritis is associated with early treatment response but not long-term outcomes. Arthritis Res Ther. 2018;20:33.