Introduction: the presence of anti-CCP is an important prognostic tool for rheumatoid arthritis (RA), but its relationship with the activity of the disease and functional capacity is still being investigated. Objectives: to study the relationship between anti-CCP and the indices of disease activity, functional capacity and structural damage, by means of conventional radiography (CR) and magnetic resonance imaging (MRI), in stabilized RA. Methods: cross-sectional study of RA patients with one to 10 years of disease. The participants were subjected to clinical evaluation with anti-CCP screening. Disease activity was assessed by means of the Clinical Disease Activity Index (CDAI) and functional capacity by means of the Health Assessment Questionnaire (HAQ). CR was analyzed by the Sharp van der Heijde index (SmvH) and MRI by the Rheumatoid Arthritis Magnetic Resonance Image Scoring System (RAMRIS). Results: 56 patients were evaluated, with median (IIq) of 55 (47.5–60.0) years, 50 (89.3%) were female among whom 37 (66.1%) were positive for anti-CCP. The median (IIq) of CDAI, HAQ, SmvH and RAMRIS were 14.75 (5.42–24.97), 1.06 (0.28–1.75), 2 (0–8) and 15 (7–35), respectively. There was no association between anti-CCP and CDAI, HAQ, SmvH and RAMRIS. Conclusion: our results did not establish the association of anti-CCP with the severity of the disease. So far, we cannot corroborate the anti-CCP as a prognostic tool in RA established.

1. Mota LMH, Cruz BA, Brenol CV, et al. Consensus of the Brazilian Society of Rheumatology for diagnosis and early assessment of rheumatoid arthritis. Revista Brasileira de Reumatologia 2011; 51(3): 199–219.

2. Markatseli TE, Papagoras C, Drosos AA. Prognostic factors for erosive rheumatoid arthritis. Clinical & Experimental Rheumatology 2010; 28(1): 114–123.

3. Kroot EJJA, De Jong BAW, Van Leeuwen MA, et al. The prognostic value of anti-cyclic citrullinated peptide antibody in patients with recent-onset rheumatoid arthritis. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology 2000; 43(8): 1831–1835.

4. Vencovský J, Macháček S, Šedová L, et al. Autoantibodies can be prognostic markers of an erosive disease in early rheumatoid arthritis. Annals of the Rheumatic Diseases 2003; 62(5): 427–430.

5. Meyer O, Labarre C, Dougados M, et al. Anticitrullinated protein/peptide antibody assays in early rheumatoid arthritis for predicting five-year radiographic damage. Annals of the Rheumatic Diseases 2003; 62(2): 120–126.

6. Maddali Bongi S, Manetti R, Melchiorre D, et al. Anti-cyclic citrullinated peptide antibodies are highly associated with severe bone lesions in rheumatoid arthritis anti-CCP and bone damage in RA. Autoimmunity 2004; 37(6–7): 495–501.

7. Forslind K, Ahlmén M, Eberhardt K, et al. Prediction of radiological outcome in early rheumatoid arthritis in clinical practice: Role of antibodies to citrullinated peptides (anti-CCP). Annals of the Rheumatic Diseases 2004; 63(9): 1090–1095.

8. Quinn MA, Gough AKS, Green MJ, et al. Anti-CCP antibodies measured at disease onset help identify seronegative rheumatoid arthritis and predict radiological and functional outcome. Rheumatology 2006; 45(4): 478–480.

9. Nell VPK, Machold KP, Stamm TA, et al. Autoantibody profiling as early diagnostic and prognostic tool for rheumatoid arthritis. Annals of the Rheumatic Diseases 2005; 64(12): 1731–1736.

10. Rönnelid J, Wick MC, Lampa J, et al. Longitudinal analysis of citrullinated protein/peptide antibodies (anti-CP) during 5-year follow up in early rheumatoid arthritis: anti-CP status predicts worse disease activity and greater radiological progression. Annals of the Rheumatic Diseases 2005; 64(12): 1744–1749.

11. Lindqvist E, Eberhardt K, Bendtzen K, et al. Prognostic laboratory markers of joint damage in rheumatoid arthritis. Annals of the Rheumatic Diseases 2005; 64(2): 196–201.

12. Sanmartí R, Gómez-Centeno A, Ercilla G, et al. Prognostic factors of radiographic progression in early rheumatoid arthritis: A two-year prospective study after a structured therapeutic strategy using DMARDs and very low doses of glucocorticoids. Clinical Rheumatology 2007; 26(7): 1111–1118.

13. Kaltenhäuser S, Pierer M, Arnold S, et al. Antibodies against cyclic citrullinated peptide are associated with the DRB1 shared epitope and predict joint erosion in rheumatoid arthritis. Rheumatology 2007; 46(1): 100–104.

14. Hetland M L, Stengaard-Pedersen K, Junker P, et al. Radiographic progression and remission rates in early rheumatoid arthritis–MRI bone oedema and anti-CCP predicted radiographic progression in the 5-year extension of the double-blind randomized CIMESTRA trial. Annals of the Rheumatic Diseases 2010; 69(10): 1789–1795.

15. Kim HH, Kim JH, Park SH, et al. Correlation of anti-cyclic citrullinated antibody with hand joint erosion score in rheumatoid arthritis patients. The Korean Journal of Internal Medicine 2010; 25(2): 201–206.

16. De Rycke L, Peene I, Hoffman IEA, et al. Rheumatoid factor and anticitrullinated protein antibodies in rheumatoid arthritis: Diagnostic value, associations with radiological progression rate, and extra-articular manifestations. Annals of the Rheumatic Diseases 2004; 63(12): 1587–1593.

17. Mewar D, Coote A, Moore DJ, et al. Independent associations of anti-cyclic citrullinated peptide antibodies and rheumatoid factor with radiographic severity of rheumatoid arthritis. Arthritis Research & Therapy 2006; 8(4): R128.

18. Silva AF, Matos AN, Lima ÁMS, et al. Association of anti-cyclic citrullinated peptide antibody and severe rheumatoid arthritis. Revista Brasileira de Reumatologia 2006; 46: 165–173.

19. Del Amo NDV, Bosch RI, Manteca CF, et al. Anti-cyclic citrullinated peptide antibody in rheumatoid arthritis: relation with disease aggressiveness. Clinical and Experimental Rheumatology 2006; 24(3): 281–286.

20. Alexiou I, Germenis A, Ziogas A, et al. Diagnostic value of anti-cyclic citrullinated peptide antibodies in Greek patients with rheumatoid arthritis. BMC Musculoskeletal Disorders 2007; 8(1): 1–7.

21. Syversen SW, Gaarder PI, Goll GL, et al. High anti-cyclic citrullinated peptide levels and an algorithm of four variables predict radiographic progression in patients with rheumatoid arthritis: Results from a 10-year longitudinal study. Annals of the Rheumatic Diseases 2008; 67(2): 212–217.

22. Nieto-Colonia AM, Santos WS, Keusseyan SP, et al. Antibodies to citrullinated peptides are not associated with the rate of joint destruction in patients with a well-established diagnosis of rheumatoid arthritis. Brazilian Journal of Medical and Biological Research 2008; 41: 188–192.

23. Gupta R, Thabah M, Aneja R, et al. Usefulness of anti-CCP antibodies in rheumatic diseases in Indian patients. Indian Journal of Medical Sciences 2009; 63(3): 92–100.

24. Kastbom A, Strandberg G, Lindroos A, et al. Anti-CCP antibody test predicts the disease course during 3 years in early rheumatoid arthritis (the Swedish TIRA project). Annals of the Rheumatic Diseases 2004; 63(9): 1085–1089.

25. Korkmaz C, Us T, Kaşifoğlu T, et al. Anti-cyclic citrullinated peptide (CCP) antibodies in patients with long-standing rheumatoid arthritis and their relationship with extra-articular manifestations. Clinical Biochemistry 2006; 39(10): 961–965.

26. Mota LM, Neto LS, Burlingame RW, et al. Disability and quality-of-life are not influenced by the prevalence of autoantibodies in early rheumatoid arthritis patients—Results of the Brasília Cohort. Revista Brasileira de Reumatologia 2012; 52(6): 819–829.

27. Hui L, Wuqi S, Yang L, et al. Diagnostic value of anti-cyclic citrullinated peptide antibodies in northern Chinese Han patients with rheumatoid arthritis and its correlation with disease activity. Clinical Rheumatology 2010; 29(4): 413–417.

28. Shidara K, Inoue E, Hoshi D, et al. Anti-cyclic citrullinated peptide antibody predicts functional disability in patients with rheumatoid arthritis in a large prospective observational cohort in Japan. Rheumatology International 2012; 32(2): 361–366.

29. Choe JY, Bae J, Lee H, et al. Relation of rheumatoid factor and anti-cyclic citrullinated peptide antibody with disease activity in rheumatoid arthritis: Cross-sectional study. Rheumatology International 2013; 33(9): 2373–2379.

30. da Mota LMH, dos Santos Neto LL, de Carvalho JF, et al. The presence of anti-citrullinated protein antibodies (ACPA) and rheumatoid factor on patients with rheumatoid arthritis (RA) does not interfere with the chance of clinical remission in a follow-up of 3 years. Rheumatology International 2012; 32(12): 3807–3812.

31. Arnett F C, Edworthy S M, Bloch D A, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology 1988; 31(3): 315–324.

32. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis & Rheumatism 2010; 62(9): 2568–2581.

33. Aletaha D, Nell V P K, Stamm T, et al. Acute phase reactants add little to composite disease activity in-

34. dices for rheumatoid arthritis: Validation of a clinical activity score. Arthritis Research & Therapy 2005; 7(4): 1–11.

35. Ferraz MB, Oliveira LM, Araujo PM, et al. Crosscultural reliability of the physical ability dimension of the health assessment questionnaire. The Journal of Rheumatology 1990; 17(6): 813–817.

36. Van der Heijde D. How to read radiographs according to the Sharp/van der Heijde method. The Journal of Rheumatology 1999; 26(3): 743–745.

37. Østergaard M, Peterfy C, Conaghan P, et al. OMERACT rheumatoid arthritis magnetic resonance imaging studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. The Journal of Rheumatology 2003; 30(6): 1385–1386.

38. Klareskog L, Stolt P, Lundberg K, et al. A new model for an etiology of rheumatoid arthritis: Smoking may trigger HLA–DR (shared epitope)–restricted immune reactions to autoantigens modified by citrullination. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology 2006; 54(1): 38–46.

39. Pedersen M, Jacobsen S, Garred P, et al. Strong combined gene–environment effects in anti–cyclic citrullinated peptide–positive rheumatoid arthritis: A nationwide case–control study in Denmark. Arthritis & Rheumatism 2007; 56(5): 1446–1453.

40. Pedersen M, Jacobsen S, Klarlund M, et al. Environmental risk factors differ between rheumatoid arthritis with and without auto-antibodies against cyclic citrullinated peptides. Arthritis Research & Therapy 2006; 8(4): R133.

41. Goeldner I, Skare TL, de Messias Reason IT, et al. Association of anticyclic citrullinated peptide antibodies with extra-articular manifestations, gender, and tabagism in rheumatoid arthritis patients from southern Brazil. Clinical Rheumatology 2011; 30(7): 975–980.

42. Aletaha D, Smolen J. The implified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): A review of their usefulness and validity in rheumatoid arthritis. Clinical and Experimental Rheumatology 2005; 23(5): S100–S108.

43. Smolen J S, Landewé R, Breedveld F C, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Annals of the Rheumatic Diseases 2014; 73(3): 492–509.

44. Ravindran V, Rachapalli S. An overview of commonly used radiographic scoring methods in rheumatoid arthritis clinical trials. Clinical Rheumatology 2011; 30(1): 1–6.

45. Hafström I, Engvall I L, Rönnelid J, et al. Rheumatoid factor and anti-CCP do not predict progressive joint damage in patients with early rheumatoid arthritis treated with prednisolone: A randomized study. BMJ Open 2014; 4(7): e005246. doi: 10.1136/bmjopen-2014-005246.

46. Gandjbakhch F, Haavardsholm E A, Conaghan P G, et al. Determining a magnetic resonance imaging inflammatory activity acceptable state without subsequent radiographic progression in rheumatoid arthritis: Results from a follow-up MRI study of 254 patients in clinical remission or low disease activity. The Journal of Rheumatology 2014; 41(2): 398–406.

47. Conaghan PG, Emery P, Østergaard M, et al. Assessment by MRI of inflammation and damage in rheumatoid arthritis patients with methotrexate inadequate response receiving golimumab: Results of the GO-FORWARD trial. Annals of the Rheumatic Diseases 2011; 70(11): 1968–1974.

48. Østergaard M, Emery P, Conaghan P G, et al. Significant improvement in synovitis, osteitis, and bone erosion following golimumab and methotrexate combination therapy as compared with methotrexate alone: A magnetic resonance imaging study of 318 methotrexate-naive rheumatoid arthritis patients. Arthritis & Rheumatism 2011 63(12): 3712–3722.

49. Gandjbakhch F, Conaghan P G, Ejbjerg B, et al. Synovitis and osteitis are very frequent in rheumatoid arthritis clinical remission: results from an MRI study of 294 patients in clinical remission or low disease activity state. The Journal of Rheumatology 2011; 38(9): 2039–2044.

50. Brown A K, Quinn M A, Karim Z, et al. Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology 2006; 54(12): 3761–3773.

51. Brown AK, Conaghan PG, Karim Z, et al. An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology 2008; 58(10): 2958–2967.