ASSOCIATION OF SEROLOGICAL STATUS WITH THE FREQUENCY OF CLINICAL AND RADIOLOGICAL REMISSION IN RHEUMATOID ARTHRITIS
Authors: Iaremenko O.B. 
Published: July 2021

Relevance. Achieving remission is one of the main goals in the treatment of patients with rheumatoid arthritis (RA). One of the determining predictors of the disease, according to the literature, is the serological variant of RA. However, there are conflicting data in scientific publications on the relationship between the presence of antibodies to cyclic citrullinated peptide (ACCP) and / or rheumatoid factor (RF) and the frequency and rate of remission. There is no unanimous opinion in the literature on the influence of the titer of serological markers of RA (ACCP and RF) on the possibility of achieving remission on the background of basic treatment, which prompted to conduct their own research to study this issue. Objective: to study the relationship between the presence / absence of serological markers of RA (ACCP, RF) and the frequency and timing of clinical and radiological remission of RA under the influence of treatment with traditional synthetic basic drugs and to analyze the relationship between ACCP and RF titers and the possibility of remission.Material and methods. The study analyzed the influence of serological status of patients with RA on the possibility and time of remission while taking the main non-biological basic drugs. The relationship between the presence and level of ACCP and / or RF and clinical and radiological remission in RA has been studied. The study included 128 patients. Analysis of RA activity and assessment of remission were performed after 6, 12 and 24 months of treatment, using the DAS28 activity scale and the dynamics of radiological changes on the Sharpe-van der Heide scale. Results. During the 2-year follow-up, clinical remission was observed three times more often in the group of patients negative for ACCP (anti-cyclic citrullinated peptide) (36.1% in the group ACCP-RF- compared with 12.5% ​​in the group ACCP + RF ( +, χ2 = 7.74, p < 0.05, and in 33.3% in the group ACCP-RF +, a significant difference compared with ACCP + RF +, χ2 = 4.55, p <0.05). Early remission (during the first 6 months of treatment) was also more common in the group of patients with no ACCP (χ2 = 10.7, p <0.01 and χ2 = 6.69, p <0.05, respectively). The rate of remission (the share of early in the structure of the total) in the four analyzed groups did not differ significantly and was 75%, 66.6%, 66.6% and 84.6%, respectively. The titer of ACCP in the group of patients who achieved remission was 240.8 ± 38.5 and did not differ significantly from that in the group of patients whose RA (rheumatoid arthritis) activity exceeded the remission threshold (187.8 ± 13.7, p> 0.05). There was also no significant difference between these two groups in the titers of the RF (rheumatoid factor): 257.9 ± 233.8 and 293.2 ± 257.3, respectively. Radiological remission was achieved in 46.7% of ACCP-negative patients and only in 10.6% of ACCP-positive patients (p <0.01). The absence of RF in the blood was also associated with a more frequent achievement of radiological remission (in 34.2% of patients) compared with the RF-positive cohort of patients (in 15.4%, p <0.05). Conclusions. It was found that the frequency of clinical remission, including early (during the first 6 months of treatment), is three times higher in patients with RA, negative for ACCP. The rate of clinical remission (ratio of early in the structure of the general) does not depend on the serological variant of the disease: about two thirds of patients in all analyzed groups achieve remission in the first half of basic therapy. Titers of the main serological markers of RA (ACCP and RF) in the onset of the disease do not affect the possibility of achieving clinical and  radiological remission. Radiological remission is observed three times more often in seronegative (for ACCP or RF) patients. Double seropositivity has an additive effect on subsequent joint destruction.