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ID PMID Title PublicationDate abstract
19393205 Long term treatment of rheumatoid arthritis with rituximab. 2009 Jun B cells play an important role in the pathogenesis of rheumatoid arthritis (RA). Rituximab is a chimeric monoclonal antibody that depletes B-cells by binding to the CD20 surface antigen that has been approved for the treatment of RA. Its efficacy has been clearly demonstrated by different clinical trials and, recently, in long-term observational studies. The use of rituximab in clinical practice has highlighted its efficacy and safety over more than 5 years of treatment, as well as to try to understand the timing for retreatment of patients relapsing after a good initial response.
20198589 Lack of association between paraoxonase-1 Q192R polymorphism and rheumatoid arthritis in s 2010 Feb 23 Decreased paraoxonase-1 (PON1) activity has been associated with rheumatoid arthritis. There are two polymorphisms in serum PON1; one differs in the amino acid at position 192 (Q192R) and the other one differs at position 55 (L55M). We looked for a possible association between Q192R polymorphism and rheumatoid arthritis. The Q192R polymorphism in 88 rheumatoid arthritis patients and 78 healthy subjects was determined using tetra amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) and PCR-restriction fragment length polymorphism (RFLP) methods. We found no significant differences between rheumatoid arthritis patients and control subjects regarding PON1 Q192R polymorphism. PON1 Q192R polymorphism was not found to be correlated with increased risk for rheumatoid arthritis in this Iranian population.
19396755 [Effects of biologic antirheumatic treatments on bone metabolism in rheumatoid arthritis a 2009 Mar Systemic inflammatory disorders like rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are characterized by extensive dysregulation of bone metabolism recognized as focal articular bone erosions, juxta-articular and systemic bone loss. The complex interactions between bone cells, osteoprotegerin/RANKL pathway and a variety of inflammatory mediators are involved in the pathogenesis of focal and systemic osteopenia. Treatments with TNF-alpha blockers inhibit inflammation-induced bone resorption and might prevent structural bone damage in RA. In some studies with anti-TNF agents, an increase in BMD has been documented in spondyloarthropathies and in RA. The B-cell depleting antibody rituximab and the T-cell costimulation blocker abatacept are emerging as other effective treatment options in RA. Studies with anti- RANKL antibody Denosumab in RA demonstrate, that treatment targeting RANKL prevents development of erosions but not inflammation. This article reviews recent scientific literature regarding the effects of modern targeted therapies on bone turnover, bone mass and focal damage of joints.
19242068 Genetic polymorphisms modifying oxidative stress are associated with disease activity in r 2009 Reactive oxygen and nitrogen species are involved in the pathology of rheumatoid arthritis (RA). Polymorphisms in genes coding for superoxide dismutases (SOD2 and SOD3), catalase (CAT), tumor necrosis factor-alpha (TNFA) and inducible NO synthase (NOS2A) may influence RA activity. We determined SOD2 Ala-9Val, SOD3 Arg213Gly, CAT C-262T, TNFA G-308A, TNFA C-857T and NOS2A (CCTTT) (n)polymorphisms in 327 RA patients. Carriers of CAT -262T and TNFA -308A allele had lower mean disease activity score of 28 joint count (DAS28) values than patients with CAT -262CC and TNFA -308GG genotypes (p = 0.014 and p = 0.046, respectively). Patients with the combination of CAT -262T and TNFA -308A allele had lower mean DAS28 values and a higher probability for low disease activity than non-carriers (p = 0.003, OR = 3.585, 95% CI = 1.538-8.357). Our results suggest that CAT and TNFA polymorphisms alone and in combination influence the activity of RA.
20980286 Urinary type II collagen C-terminal peptide is associated with synovitis and predicts stru 2011 Feb OBJECTIVES: In rheumatoid arthritis, high levels of the cartilage turnover biomarker C-terminal cross-linking telopeptide of type II collagen (CTX-II) predict an increased risk of radiological progression. In very early inflammatory arthritis erosions are uncommon, therefore CTX-II requires validation against early markers of inflammatory arthritis such as power Doppler ultrasound (PDUS) synovitis and bone mineral density (BMD) loss. METHODS: In 50 subjects with 12 weeks or less of inflammatory hand symptoms, urinary CTX-II and PDUS were performed at baseline and hand BMD at baseline and 12 months. CTX-II data were log transformed to a normal distribution. Associations between variables were examined using Pearson's r/Spearman's ρ correlations. RESULTS: The mean 12- month change in BMD was -0.0068 g/cm² and the geometric mean for baseline CTX-II/creatinine was 245.89 ng/mmol. Log-transformed baseline CTX-II showed a substantive negative association with change in average BMD over 12 months, controlling for baseline BMD and erythrocyte sedimentation rate (r=-0.359, p=0.044). The median total PDUS score was 3.0 and baseline CTX-II was significantly associated with baseline total PDUS (Spearman's ρ=0.482, p=0.002). CONCLUSION: Urinary CTX-II correlates with PDUS synovitis and hand BMD reduction very early in the course of inflammatory arthritis, suggesting that CTX-II has potential as a biomarker in very early inflammatory arthritis.
19594004 [Cause analysis and clinical management of postoperative wound complications after total k 2009 Jun OBJECTIVE: To investigate the causes and the clinical treatment methods of postoperative wound complications following total knee arthroplasty (TKA). METHODS: From June 2005 to August 2008, 486 cases (576 knees, including 314 left knees and 262 right knees) underwent primary TKA using standard midline incision and medial parapatellar arthrotomy. There were 146 males (172 knees) and 340 females (404 knees) aged 51-86 years old (average 61.3 years old). The duration of disease was 3-35 years. Primary diseases included: 138 cases (156 knees) of rheumatoid arthritis, 282 cases (348 knees) of osteoarthritis, 46 cases (49 knees) of traumatic arthritis, 20 cases (23 knees) of pigmented villonodular synovitis. The factors of etiology, deformity correction, duration of tourniquet use and wound drainage were analyzed to determine the cause of postoperative wound complication. RESULTS: Postoperatively, 37 cases (43 knees) had wound complications and the rate of incidence was 7.5%, including 13 cases (15 knees) of aseptic exudation, 3 cases (4 knees) of fat liquefaction, 4 cases (4 knees) of subcutaneous hematoma, 8 cases (9 knees) of flap margin necrosis, 6 cases (7 knees) of superficial infection, 3 cases (4 knees) of red swollen joint with increased skin temperature and deep infection. All 37 patients recovered after symptomatic treatment. Among those 37 cases, patients with rheumatoid arthritis had a higher incidence rate of wound complication than the patients with other primary diseases (P < 0.05). The incidence rate of patients with deformity correction more than or equal to 20 degree was significantly higher than that of other patients (P < 0.05). The duration of using tourniquet was (86 +/- 15) minutes for patients with wound complication, and (78 +/- 8) minutes for patients without wound complication, indicating there was a significant difference (P < 0.01). Wound complication occurred in 22 knees (5.1%) with autologous blood transfusion absorber, 11 knees (11.5%) with negative pressure attraction, and 10 knees (19.2%) receiving no drainage. The incidence rate of postoperative wound complication in patients without drainage was obviously higher than that in patients with drainage (P < 0.05). CONCLUSION: Patients with rheumatoid arthritis are more likely to have wound complication after TKA. Postoperative wound drainage and short duration of tourniquet application help decrease the incidence of complications. It is necessary to make early definitive diagnosis of postoperative wound complication, and provide proactive treatment.
20843908 Comparative analysis of disease activity measures, use of biologic agents, body mass index 2010 Dec OBJECTIVE: To compare disease activity, radiographic features, and bone density in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) matched cohorts. METHODS: Disease activity and radiographic data in the Consortium of Rheumatology Researchers of North America database from 2001 to 2008 were compared for 2481 patients with PsA and 17,107 patients with RA subsequently matched for age, gender, and disease duration. Radiographic outcomes included presence of erosions, and joint deformity. In addition, bone mineral density (BMD) scores for lumbar spine (L-spine) and femoral neck were compared using the same matching criteria plus weight and smoking status. RESULTS: Tender (4.5 vs 3.4, p < 0.001) and swollen (4.4 vs 2.9, p < 0.012) joint counts, and modified Health Assessment Questionnaire scores were significantly higher (0.4 vs 0.3, p < 0.001) in patients with RA compared with patients with PsA. Patient general health and pain scores were also higher in patients with RA vs patients with PsA. Joint erosions (47.4% vs 37.6%, p = 0.020) and deformity (25.2% vs 21.6%, p = 0.021) were more prevalent in RA than PsA. In multivariate analysis, a reduced prevalence of erosions in PsA vs RA was noted (OR 0.609, p < 0.001). After matching, T-scores for L-spine (-0.54 vs -0.36, p = 0.077) and femoral neck (-0.88 vs -0.93, p = 0.643) were similar in patients with RA and patients with PsA, although body weight was a major confounder. CONCLUSION: The level of disease activity and radiographic damage was significantly higher for RA vs PsA subjects, although the magnitude of differences was relatively small. BMD levels were comparable between cohorts. Outcomes in patients with PsA and patients with RA may be more similar than previously reported.
20447953 Trends in treatment and outcomes of rheumatoid arthritis in Germany 1997-2007: results fro 2010 Oct BACKGROUND: New strategies and options for the treatment of rheumatoid arthritis (RA) have evolved during the past decade. A study was undertaken to investigate to what extent this influenced daily rheumatological care and how this translates into clinical and patient-reported outcomes. METHODS: Data from a total of 38 723 outpatients with RA enrolled in the National Database of the German Collaborative Arthritis Centres in the years 1997-2007 were analysed. The cross-sectional annual data were compared to detect time trends. RESULTS: Between 1997 and 2007 the prescription of combinations of traditional disease-modifying antirheumatic drugs (DMARDs) increased from 8% of all patients to 23%; biological agents were prescribed to 16% of patients with RA in 2007. The mean disease activity (DAS28) fell from 4.5 to 3.4 (median 4.5-3.2). The percentage of patients with low disease activity (DAS28 <3.2) increased significantly from 23% to 49%. The proportion of patients with ≥6 swollen joints fell from 43.1% in 1997 to 8.1% in 2007 and, in those with ≥6 tender joints, from 46.3% to 15.8%. There was a large decrease in the total annual number of days of sick leave due to the rheumatic condition from 27.2 to 8.8 days per gainfully employed person. This reduction is far beyond the decline in the general population. There was also a tendency to higher participation in the work force, specifically in older patients, reflecting the trend seen in the general population. CONCLUSIONS: The intensity of drug treatment in patients with RA has increased during the past 7 years. This has been accompanied by not only a decrease in disease activity but also a considerable reduction of economic losses due to sick leave and permanent work disability.
20655010 Reconstructing the rheumatoid forefoot. 2010 Sep INTRODUCTION: The standard procedure when operating on the rheumatoid forefoot is resection arthroplasty of the metatarsophalangeal joints of the lesser rays. Good clinical results (with a follow-up of over 10 years) have been reported when this technique is used. Another technique is repositioning of the metatarsophalangeal subluxation or dislocation of the lesser rays. AIM: To assess the results of forefoot reconstruction using the repositioning technique performed in 54 feet (39 patients) by one surgeon using this technique. METHODS: 39 RA patients (15 bilateral, 54 feet) were treated with the technique of repositioning the metatarsophalangeal subluxation or dislocation. All surgery was performed by one orthopaedic surgeon. In case of severe deformity or degeneration of the metatarsophalangeal joint of the hallux, an arthrodesis was performed. All patients were reviewed after a mean follow-up of 40 months (range 12-72 months) and an American Orthopaedic Foot and Ankle Society (AOFAS) foot score, and Foot Function Index (FFI) were obtained. RESULTS: When, in addition to repositioning the metatarsophalangeal joints, an arthrodesis of the hallux was performed, the mean AOFAS-forefoot score was 69.80 (SD=11.8) at a mean of 40 months (SD=15.6 months) postoperatively. In cases with no operation on the hallux, the AOFAS score was 42.2 (SD=18.8) (p=0.001). The postoperative FFI-scores were 23.0 (SD=17.5) and 43.9 (SD=14.6) respectively (p=0.026). When comparing the patients who were satisfied (satisfaction VAS>7) and those who were not, the most important factor was also fusion of the first metatarsophalangeal (MPJ) joint, without a fusion only 50% was satisfied, with a fusion the satisfaction rate was 93%. In four patients a recurrence of the deformity of one of the lesser rays developed, for which a re-operation has been performed. CONCLUSIONS: Reconstruction of the rheumatoid forefoot by repositioning the metatarsophalangeal joints of the lesser rays, thereby preserving the joints, can be considered as a procedure that provides improvement in the clinical outcome. Best results were seen in patients in whom, in addition to reconstruction of the lesser rays, an arthrodesis of the hallux was performed.
19818166 Anti-tumour necrosis factor therapy and B cells in rheumatoid arthritis. 2009 The efficacy of B-cell depletion therapy in rheumatoid arthritis (RA) has led to a renewed interest in B cells and their products and the role they play in the pathogenesis of the disease. Agents blocking tumour necrosis factor (TNF) are also very effective in the treatment of RA. It has long been known that the use of anti-TNF therapy can be associated with development of anti-nuclear and anti-double-stranded DNA antibodies and, more rarely, a lupus-like syndrome. Recently, studies have been published investigating further possible effects of anti-TNF agents on B cells and whether these could contribute to their effectiveness in RA.
21097799 Clinical and ultrasonographic remission determines different chances of relapse in early a 2011 Jan OBJECTIVES: Treatment of rheumatoid arthritis (RA) should aim at full remission. The aims of this study were to define: (1) how many patients reached ultrasound power Doppler (US-PD) remission in a cohort of patients with early RA (ERA) compared with longstanding RA (LSRA); (2) possible predictors of US-PD remission; and (3) how many patients with and without US-PD remission relapsed after 1 year of follow-up in ERA and LSRA. METHODS: 48 patients with ERA and 46 with LSRA with disease activity score <1.6 underwent US assessment. Six hand and wrist joints were studied for active synovitis. 56.2% of patients with ERA and 50.0% of those with LSRA fulfilled American College of Rheumatology (ACR) remission criteria. RESULTS: 43.7% of patients with ERA and 17.4% of those with LSRA had no evidence of synovitis at US evaluation. Using a stricter clinical definition of remission (ie, ACR criteria), US evaluation confirmed clinical remission in 66.7% of patients with ERA and 26.1% of those with LSRA. Early disease was predictive of clinical US remission. 20.0% of patients with RA who had a negative PD signal at the US evaluation had a flare during the 12-month follow-up period compared with 47.1% of patients who had a positive PD signal. CONCLUSION: US-PD remission occurs in half of patients with ERA and in a minority of patients with LSRA in clinical remission. Early disease seems to be the major determinant of full remission.
19435971 Association of measles virus with rheumatoid arthritis. 2009 May OBJECTIVE: Rheumatoid arthritis (RA) is a chronic inflammatory polyarthritis; while the cause is unknown, it has been speculated that an infectious agent could be the trigger for the disease. Numerous attempts at isolating an agent have been unsuccessful. Our purpose was to identify a virus from diseased tissue from a patient with RA. METHODS: Diseased tissue taken at the time of knee replacement surgery from a patient with RA was inoculated into several cell lines and observed for cytopathic effect. Cells from the tissue were also grown as explants and were examined for viruses. Synovial fluid drawn 4 years prior to the surgery and frozen at -70 degrees C was also inoculated into cell lines. Following the development of a cytopathic effect and identification of the agent, sera from 50 patients with rheumatoid factor (RF)-negative RA were examined for IgM antibodies to the agent. RESULTS: After many inoculations and numerous subpassages, measles virus was identified in 6 cell lines inoculated with either the minced tissue or synovial fluid. Six cell lines co-cultivated with one or more of 9 explants also showed the presence of measles virus. Measles virus was confirmed by immunofluorescence and by neutralization. Eleven of 50 (22%) sera samples from patients with RF-negative RA had IgM antibodies to measles virus recombinant nucleoprotein. CONCLUSION: There is an association between measles virus and RA.
19208558 Thrombin-cleaved osteopontin in synovial fluid of subjects with rheumatoid arthritis. 2009 Feb OBJECTIVE: Osteopontin (OPN) is an extracellular matrix glycoprotein that has been recognized as a potential inflammatory cytokine. The function of OPN is modulated by protease digestion, and a thrombin-cleaved form of OPN is involved in the pathogenesis of various inflammatory disorders. We examined thrombin-cleaved OPN products in synovial fluid from patients with rheumatoid arthritis (RA) and osteoarthritis (OA). METHODS: Synovial fluid samples were obtained from knees of 20 patients with RA and 111 patients with OA. Thrombin-cleaved OPN product was determined using Western blotting. Levels of thrombin- cleaved and full-length OPN in synovial fluid were determined by ELISA. Synovia were analyzed by immunohistochemistry using an antibody specific to the thrombin-cleaved form. RESULTS: Immunoblotting showed the presence of thrombin-cleaved OPN in synovial fluid from patients with RA and OA. ELISA results showed no difference between concentrations of full-length OPN in the synovial fluid of RA and OA patients; however, thrombin-cleaved OPN concentrations in RA synovial fluid samples were roughly 30-fold higher compared with OA samples (p < 0.001). Synovial fluid concentrations of thrombin-cleaved OPN in RA did not correlate with C-reactive protein levels. Immunohistochemistry of the synovium showed stronger reactivity in RA than in OA samples. CONCLUSION: Local generation of thrombin-cleaved OPN was increased in RA joints. Thrombin-cleaved OPN may be a useful biochemical marker of RA.
19172227 Treatment of juxta-articular intraosseous cystic lesions in rheumatoid arthritis patients 2009 In patients with rheumatoid arthritis (RA), juxta-articular intraosseous cystic lesions may cause spontaneous pathological fractures. The outcome of curettage and the packing of such lesions with interconnected porous calcium hydroxyapatite ceramic (IP-CHA) was investigated. Twelve lesions were treated in ten RA patients (three men and seven women with a mean age of 59 years). Ten lesions were associated with impending pathological fracture involving the articular surface. In all patients, curettage and packing of the bone cavity with IP-CHA were done. Assessment was based on final radiographs obtained an average of 30 months after surgery (range 10-47 months). Absorption of the implanted IP-CHA, expansion of the lesion, implant incorporation into host bone, and postoperative fractures were investigated. At final follow-up, there was no absorption of the implanted IP-CHA in any of the lesions. Expansion of the radiolucent area was only noted in one lesion. Seven of the other 11 lesions showed major incorporation of IP-CHA into host bone, while minor incorporation was seen in four lesions. There were no postoperative fractures. In conclusion, curettage and packing with IP-CHA is a feasible method of preventing pathological fracture due to juxta-articular intraosseous cystic lesions in RA patients.
19585379 Comparison of three rheumatoid arthritis disease activity scores in clinical routine. 2009 OBJECTIVE: To evaluate whether the revised disease activity cut-off values for the Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI) are in congruence with the Disease Activity Score including a 28-joint count (DAS28) disease activity criteria in daily clinical routine. PATIENTS AND METHODS: A total of 570 rheumatoid arthritis (RA) outpatients were assessed and categorized according to the DAS28, the SDAI, and the CDAI. These results were compared to the respective DAS28 disease activity categories. Statistical evaluation was carried out by calculating alpha, the Spearman rank correlation, and kappa-statistics. RESULTS: DAS28, SDAI, and CDAI levels were significantly correlated to one another on a group level (p < 0.001). Internal consistency was the highest for the CDAI (alpha = 0.783) and the lowest for the DAS28 (alpha = 0.664). Kappa-statistics revealed a substantial degree of agreement with respect to mild, moderate, and high disease activity according to the three scores, with exceptions concerning the definition of a remission-like state. Further categorization showed that an additional 44% of patients were found to be in remission according to the DAS28 disease activity criteria relative to those defined by the SDAI or the CDAI disease activity categories respectively. CONCLUSION: The revised SDAI limits for disease activity and the respective CDAI thresholds proved to be in congruence with the DAS28 disease activity categories in daily clinical routine. The SDAI and the CDAI were found to be more stringent in defining remission.
21162502 Femoral corrective osteotomy for malunited supracondylar femoral fracture after TKA in a p 2010 Dec 1 This article presents a case of femoral corrective osteotomy for malunited supracondylar femoral fracture after total knee arthroplasty (TKA) in a patient with rheumatoid arthritis. The patient underwent 1-stage bilateral TKA and 2-stage bilateral total hip arthroplasty 17 years prior at our institution. Her fall 10 years before led to a supracondylar femoral fracture that was treated nonoperatively for 3 months and led to malunion. Complaints of mild right knee pain and remarkable varus deformity were observed. On examination, the right knee was not swollen and tender. Range of motion (ROM) of the right knee was 0° to 130°. The patient needed crutches to ambulate. Knee score and function scores, according to the Knee Society clinical rating system, were 65 and 25 points, respectively. Radiographs after malunion showed remarkable varus knee and the femorotibial angle was 197°. At the time of surgery, the components were stable and bone union was completed. Valgus corrective osteotomy of the femur was performed using a retrograde intramedullary nail, with satisfactory results at 10-year follow-up. The patient is able to walk without a cane and has 0° to 130° ROM. Knee and function scores were 88 and 80 points, respectively. Radiographs showed complete bone union and the femorotibial angle was 179° with no loosening of the prostheses. Femoral corrective osteotomy is recommended for malunited supracondylar femoral fracture after TKA.
19504098 Matrix metalloproteinase gene polymorphisms in patients with rheumatoid arthritis. 2010 Jan Several genetic factors seem to be involved in the pathogenesis of rheumatoid arthritis (RA). The aim of this study was to analyze whether functional polymorphisms in the promoter region of the MMP-1, -3 and -9 genes were associated with RA. The study population comprises 110 RA patients and 100 healthy controls. The -1607 1G/2G MMP-1, -1171 5A/6A MMP-3, and -1562 C/T MMP-9 polymorphisms were analyzed. The frequency of the 5A allele of MMP-3 gene was significantly higher in the controls when compared with the RA patients (0.45 vs. 0.32, P < 0.01). No significant differences were observed in the allele frequencies for the MMP-1 and -9 polymorphisms between RA patients and controls. Individuals carrying MMP-3 5A allele have significant higher frequency of extra-articular manifestations and rheumatoid nodules than individuals homozygous for 6A allele (P < 0.05). The results presented in this study provide evidence of an association between the MMP-3 gene polymorphism and RA.
20378385 Visceral leishmaniasis and macrophagic activation syndrome in a patient with rheumatoid ar 2010 May BACKGROUND: Visceral leishmaniasis is a protozoan infection usually asymptomatic, but can progress to fatal disease in immunocompromised hosts, especially in HIV patients. Visceral leishmaniasis is rare among patients under immunosuppressive therapies, and even more among patients under anti-TNF-alpha treatment, where only four cases have been described. OBJECTIVE: 1) To describe a patient with rheumatoid arthritis receiving adalimumab who developed fever, pancytopenia, splenomegaly, and extreme hyperferritinemia. 2) To perform a review of the published cases of visceral leishmaniasis and anti-TNF-alpha therapy, and cases of coexisting leishmaniasis and macrophagic activation syndrome by search in PubMed (period 1991-2008). RESULTS: Visceral leishmaniasis was established by bone marrow aspiration, and although there was no histological confirmation, according to HLH-2004 criteria, a secondary macrophagic activation syndrome was established. The patient had a favourable outcome. CONCLUSION: We report herein the fifth case of visceral leishmaniasis in a patient under TNF-alpha therapy, and the first one, to our knowledge, presenting a consequent secondary macrophagic activation syndrome.
19526307 Leflunomide-induced polymyositis in a patient with rheumatoid arthritis. 2009 Although rheumatoid arthritis (RA) and myositis are major autoimmune diseases, co-occurrence of the two is rare. We treated a patient who developed polymyositis (PM) following the treatment of RA with leflunomide. Prednisolone (PSL) in combination with methotrexate (MTX) was effective in managing the PM, but the RA relapsed during the treatment. Based on the clinical course, we suspect that the PM was induced by the leflunomide treatment and suggest that clinicians should consider the possibility of this rare adverse event in cases of cholestyramine-resistant elevation of transaminases.
20236483 The use of citrullinated peptides and proteins for the diagnosis of rheumatoid arthritis. 2010 The presence or absence of antibodies to citrullinated peptides/proteins (ACPA) is an important parameter that helps a clinician set a diagnosis of early rheumatoid arthritis and, hence, initiate treatment. There are several commercial tests available to measure ACPA levels, although it can be difficult to decide what the best test for a given clinical question is. We analyzed literature data in which the diagnostic and other properties of various ACPA tests are compared. The results show that for diagnostic purposes the CCP2 test has the highest specificity, the highest sensitivity in stratified studies and the highest positive predictive value. For the prediction of future joint destruction the CCP2, MCV, and CCP3 tests may be used. The ability to predict the likelihood of not achieving sustained disease-modifying antirheumatic drug-free remission was highest for the CCP2 test. Finally, the levels of anti-CCP2 and anti-CCP3 (and possibly anti-mutated citrullinated vimentin) in rheumatoid arthritis patients are not significantly influenced by TNFalpha blocking agents.