Article Text

Download PDFPDF

Original article
Impact of the combined presence of erosions and ACPA on rheumatoid arthritis disease activity over time: results from the METEOR registry
  1. Sytske Anne Bergstra1,
  2. Maura C Couto2,
  3. Nimmisha Govind3,
  4. Arvind Chopra4,
  5. Karen Salomon Escoto5,
  6. Elizabeth Murphy6,
  7. Tom WJ Huizinga1 and
  8. Cornelia F Allaart1
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Hospital Sao Teotónio, Viseu, Portugal
  3. 3University of the Witwatersrand, Johannesburg, South Africa
  4. 4Center for Rheumatic Diseases, Pune, India
  5. 5Univeristy of Massaschusetts Medical School, Rheumatology Center, UMass Memorial Medical Center, Worcester, Massachusetts, USA
  6. 6University Hospital Wishaw, Wishaw, UK
  1. Correspondence to Dr Sytske Anne Bergstra; s.a.bergstra{at}


Objective To investigate associations between baseline presence of erosions and/or anti-citrullinated protein antibodies (ACPA) on functional ability, disease activity and treatment survival over time.

Methods Real life data from newly diagnosed rheumatoid arthritis patients were identified in the international METEOR registry. Patients were grouped according to presence/absence of ACPA and/or erosions at baseline. Associations between the presence of ACPA and/or erosions (four groups) with the change of Disease Activity Score (DAS) and Health Assessment Questionnaire (HAQ) over time were assessed using linear mixed models during maximum 6 or maximum 12 months from baseline. Treatment survival was assessed using multiple failure-times Cox regression.

Results Data were included from 701 ACPA‒/erosions‒, 334 ACPA‒/erosions+, 1585 ACPA+/erosions‒ and 1993 ACPA+/erosions+ patients. We found statistically significant differences in DAS and HAQ change over time between the four groups, both after maximum follow-up durations of 6 and of 12 months, but after stratification differences proved small and not clinically meaningful. Patients in the ACPA‒/erosions‒ group were less likely to switch treatment compared with the ACPA+/erosions‒ reference group (p<0.001). The other two ACPA/erosions groups did not differ from the reference group.

Conclusions In this analysis of worldwide real life data, we found statistically significant, but clinically irrelevant differences in treatment response to initial disease modifying anti-rheumatic drug therapies as measured by DAS and HAQ in ACPA‒/erosions‒, ACPA‒/erosions+, ACPA+/erosions‒ and ACPA+/erosions+ rheumatoid arthritis patients. However, after maximum follow-up durations of 6 and 12 months all groups had a similar response to initial treatment, but with a lower likelihood to switch treatment for ACPA‒/erosions‒ patients during the first year of follow-up.

  • rheumatoid arthritis
  • ACPA
  • erosions
  • disease activity
  • HAQ
  • treatment

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors SAB and CFA contributed to the design, analysis and interpretation of the data. MCC, NG, AC, KSE, EM, TWJH and CFA contributed to the acquisition of data. SAB drafted the work. All authors revised the manuscript and read and approved the final version of the document.

  • Funding This work was supported by a research grant from Bristol Myers Squibb.

  • Competing interests EM has received funding from Roche to audit work on behalf of the Scottish Society for Rheumatology and received support from AbbVie and UCB to attend meetings. TWJH the department of rheumatology of the LUMC has received research support/lecture fees/consultancy fees from the Dutch Arthritis Foundation, Abblynx, Merck, UCB, Bristol Myers Squibb, Biotest AG, Janssen, Pfizer, Novartis, Roche, Sanofi-Aventis, Abbott, Crescendo Bioscience, Galapagos, Nycomed, Boeringher, Takeda, Zydus, Epirus and Eli Lilly. The other authors declared no conflicts of interest.

  • Patient consent for publication Not required.

  • Ethics approval The METEOR registry contains completely anonymised data which was gathered during daily practice. Treatment, timing of follow-up visits and measurements were non-protocolled. Therefore, medical ethics board approval was not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.