Anti-type II collagen antibodies are associated with early erosions in Rheumatoid Arthritis

Introduction: We have previously reported that high levels of antibodies specific for type II collagen (anti-CII) were associated with early inflamma-tion and immune complex (IC)-associated pro-inflammatory cytokine pro-duction in vitro. In contrast, antibodies specific for cyclic citrullinated pep-tides (anti-CCP) were associated with late inflammation and late erosions in the same group of RA patients. We therefore hypothesized that anti-CII are also associated with early erosions in this patient group. Patients and Methods: Two-hundred-and-fifty-six patients from an early RA cohort were included. The Larsen score was used to score 32 joints. The results were obtained at baseline and after one and two years, respectively.Results: Anti-CII antibodies were significantly associated with increased Larsen score at disease onset using a high cut-off based on biological effects of anti-CII IC-associated cytokine production in vitro. Sizeable differences between the groups were sustained at all investigated time points. A sizeable but non-significant difference at baseline between anti-CII positive and anti-CII negative patients with RA was recorded using a conventional 95th per-centile cut-off. These differences were not evident after 1 or 2 years.Conclusion: In contrary to anti-CCP, anti-CII positive patients with RA have increased joint destruction at baseline. Anti-CII thus characterizes an early inflammatory/destructive phenotype, in contrast to the late appearance of an inflammatory/destructive phenotype in anti-CCP positive RA patients.