Comparative Socio-Demographic and Disease Related Characteristics between Anti-CCP Positive and Negative Rheumatoid Arthritis Patients

Original Research Article Background: As an autoimmune disease, rheumatoid arthritis (RA) is characterized by the production of autoantibodies specific for the disease like rheumatoid factor, antibodies against cyclic citrullinated peptides (AntiCCP) and non-specific ones, like antinuclear autoantibodies (ANA). Comparative data regarding the sociodemographic and disease related characteristics between anti-CCP positive and negative RA patients are very potential components in the treatment arena of RA. Aim of the study: The aim of this study was to collect information regarding the socio-demographic and disease related characteristics between anti-CCP positive and negative RA patients. Methods: This was an observational cross sectional study which was conducted in the Rheumatology Out Patient Department and Medicine Indoor, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh during the period from January 2009 to December 2010. This study was approved by the ethical committee of the mentioned hospital. In total 165 patients with RA attended the mentioned units with proper documents were finalized as the study population. A pre-designed semi-structured questioner was used in collecting patient data. All data were collected, processed, analyzed and disseminated by MS-Office and SPSS version 20 as per need. Result: There was no statistically significant difference in term of age (p=0.052), sex (p=0.461), marital status (p= 0.575), family history of RA (p=0.357), level of education (p=0.448), family income (p=0.400) between anti-CCP positive and negative groups. So all demographic characteristics were almost identically distributed between the study groups. The DAS 28 was significantly higher in anti-CCP positive patients than anti-CCP negative patients (6.3±0.92 vs. 5.9±0.8, p = 0.017). The number of tender joint count and swollen joint count were significantly higher in the anti-CCP positive group than those in the anti-CCP negative group (31±12 vs. 24±12, p=0.003; 6±5 vs. 3±2, p=0.002 respectively). ESR (mean±SD) was 61.7±31.4 in Anti-CCP positive group and 48.9±19.6 in Anti-CCP negative group, which was significantly higher in the Anti-CCP positive group (P=0.032). Anaemia was significantly higher in Anti-CCP positive group (55.3% vs. 33.3%, p=0.023). Patient's global assessment of disease activity and physician's global assessment of disease activity were also higher in the Anti-CCP positive group than negative group, which was nearly significant (57.0±15.4 vs. 52.7±9.8, p-0.054; 51.0±15.6 vs. 45.2±12.5, p= 0.053 respectively). On the other hand, there was no statistically significant difference in term of disease duration, VAS, HAQ, morning stiffness > 60 minutes, CRP, Haemoglobin, platelet count and joint deformity (p> 0.05). In comparison of disease activity indices level between Anti-CCP positive and negative patients with RA we observed DAS 28 was not associated with anti-CCP positivity (P=0.410), HAQ score < 1 was significantly less in patients with anti-CCP negativity (P=0.02), patient’s global assessment and physician’s global assessment score were much higher in the anti-CCP positive group and number of tender joint count was significantly higher in the former group. Conclusion: We observed, all demographic characteristics were almost identically distributed between the study groups. In disease activity analysis we found significant correlations between anti-CCP positive and negative RA patient groups in some parameters like DAS 28 score, tender joint count, swollen joint count, ESR, anaemia, Patient's global assessment of disease activity and physician's global assessment of disease activity. But when anti-CCP antibody status was compared with differing levels of disease activity parameters no significant association evident (P>0.05).