Background
Methods
Early undifferentiated polyarthritis (EUPA) patient cohort
Disease variables
RA-associated antibodies
Outcomes
Serum 14-3-3η measurements
Statistical methods
Results
Elevated 14-3-3η serum protein levels at baseline and over time
Variable | Number | Value |
---|---|---|
Age, median (IQRa), years | 331 | 60 (49.4–68.6) |
Age ≥65 years, n (%) | 331 | 122 (36.9) |
Women, n (%) | 331 | 205 (61.9) |
Current smoker, n (%) | 330 | 69 (20.9) |
Symptom duration, median (IQR), months | 331 | 3.1 (1.7–5.7) |
Body mass index, median (IQR), kg/m2
| 309 | 26.1 (23–29.8) |
25–29.9, n (%) | 104 (33.7) | |
≥30, n (%) | 74 (23.9) | |
Swollen joint count, 28 joints, median (IQR) | 330 | 9 (5–15) |
Tender joint count, 28 joints, median (IQR) | 329 | 9 (4–16) |
Fulfilling 1987 ACR criteria for rheumatoid arthritis, n (%) | 331 | 275 (83.1) |
Fulfilling 2010 EULAR/ACR criteria for rheumatoid arthritis, n (%) | 330 | 281 (85.2) |
Fulfilling 1987 or 2010 sets of criteria for rheumatoid arthritis, n (%) | 330 | 304 (92.1) |
Disease Activity Score, 28 joints-C-reactive protein, median (IQR) | 328 | 5.1 (4.2–6.2) |
Simplified Disease Activity Index, median (IQR) | 328 | 30.1 (19.8–45.2) |
Modified Health Assessment Questionnaire, median (IQR) | 329 | 0.8 (0.4–1.4) |
Total SvH score, median (IQR) | 328 | 2 (0–6) |
SvH erosion score, median (IQR) | 328 | 1 (0–3) |
Erythrocyte sedimentation rate, mm/h, median (IQR) | 331 | 33 (17–46) |
C-reactive protein, mg/L, median (IQR) | 331 | 13.1 (4.5–32.0) |
C-reactive protein >8.0 mg/L | 331 | 207 (62.5) |
Rheumatoid factor-positive, ≥40 IU/ml | 331 | 146 (44.1) |
Anti-CCP2 positive | 331 | 133 (40.2) |
Anti-Sa positive | 331 | 73 (22.1) |
14-3-3η, ng/ml, median (IQR) | 331 | 0.1 (0.0–1.9) |
14-3-3η positive, ≥0.19 ng/ml | 331 | 153 (46.2) |
14-3-3η positive, ≥0.50 ng/ml | 331 | 119 (36.0) |
Complementarity of 14-3-3η in identification of patients with early RA
1987+/2010+ | 1987+/2010– | 1987–/2010+ | 1987–/20– | Total | Incremental benefit of 14-3-3η | |
---|---|---|---|---|---|---|
(n = 252) number (%) | (n = 23) number (%) | (n = 29) number (%) | (n = 26) number (%) | (n = 330a) number (%) | ||
Rheumatoid factor+ | 140 (55.6) | 0 (0) | 6 (20.7) | 0 (0) | 146 (44.2) | NA |
Anti-CCP2+ | 119 (47.2) | 0 (0) | 14 (48.3) | 0 (0) | 133 (40.3) | NA |
Anti-Sa+ | 67 (26.6) | 0 (0) | 6 (20.7) | 0 (0) | 73 (22.1) | NA |
Rheumatoid factor + and/or anti-CCP2+ | 153 (60.7) | 0 (0) | 14 (48.3) | 0 (0) | 167 (50.6) | NA |
Rheumatoid factor + and/or anti-CCP2+ and/or anti-Sa+ | 155 (61.5) | 0 (0) | 15 (51.7) | 0 (0) | 170 (51.5) | NA |
14-3-3η ≥0.19 ng/ml | 134 (50.6) | 1 (10) | 14 (43.8) | 4 (17.4) | 153 (46.4) | NA |
14-3-3η ≥0.50 ng/ml | 111 (44.0) | 0 (0) | 8 (27.6) | 0 (0) | 119 (36.1) | NA |
14-3-3η ≥ 0.19 ng/ml and/or | ||||||
Rheumatoid factor+ | 161 (63.9) | 1 (4.3) | 15 (51.7) | 4 (15.4) | 181 (54.8) | 24.0 %*** |
Anti-CCP2+ | 158 (62.7) | 1 (4.3) | 19 (65.5) | 4 (15.4) | 182 (55.2) | 36.8 %*** |
Anti-Sa+ | 144 (57.1) | 1 (4.3) | 15 (51.7) | 4 (15.4) | 164 (49.7) | 124.7 %*** |
Rheumatoid factor + and/or anti-CCP2+ | 168 (66.7) | 1 (4.3) | 19 (65.5) | 4 (15.4) | 192 (58.2) | 15.0 %*** |
Rheumatoid factor + and/or anti-CCP2+ and/or anti-Sa+ | 170 (64.2) | 1 (10) | 19 (59.4) | 4 (17.4) | 194 (58.8) | 14.1 %*** |
14-3-3η ≥ 0.50 ng/ml and/or | ||||||
Rheumatoid factor+ | 150 (59.5) | 0 (0) | 9 (31.0) | 0 (0) | 159 (48.2) | 8.9 %*** |
Anti-CCP2+ | 147 (58.3) | 0 (0) | 15 (51.7) | 0 (0) | 162 (49.1) | 21.8 %*** |
Anti-Sa+ | 126 (50.0) | 0 (0) | 11 (37.9) | 0 (0) | 137 (41.5) | 87.7 %*** |
Rheumatoid factor + and/or anti-CCP2+ | 159 (63.1) | 0 (0) | 15 (51.7) | 0 (0) | 174 (52.7) | 4.2 %** |
Rheumatoid factor + and/or anti-CCP2+ and/or anti-Sa+ | 161 (63.9) | 0 (0) | 16 (55.2) | 0 (0) | 177 (53.6) | 4.1 %** |
Defining the optimal 14-3-3η threshold to predict worse radiographic outcomes
ΔSvH ≥ 5 | ΔErosion ≥ 5 | ||||
---|---|---|---|---|---|
Baseline variables | Total, number | at 60 m, number (%) | RR (95 % CI) from GEE over time | at 60 m, number (%) | RR (95 % CI) from GEE over time |
14-3-3η, ng/ml | |||||
<0.19 | 169 | 73 (43.2) | 1 | 48 (28.4) | 1 |
0.19–0.50 | 31 | 12 (38.7) | 0.86 (0.52–1.43) | 10 (32.3) | 0.93 (0.51–1.70) |
≥0.50 | 115 | 74 (64.3) | 1.57 (1.24–1.97) *** | 60 (52.2) | 2.01 (1.49–2.72) *** |
14-3-3η, ng/ml | |||||
<0.19 | 169 | 73 (43.2) | 1 | 48 (28.4) | 1 |
≥0.19 | 146 | 86 (58.9) | 1.40 (1.11–1.77) ** | 70 (47.9) | 1.77 (1.31–2.38) *** |
14-3-3η, ng/ml | |||||
<0.50 | 200 | 85 (42.5) | 1 | 58 (29.0) | 1 |
≥0.50 | 115 | 74 (64.3) | 1.60 (1.28–2.00) *** | 60 (52.2) | 2.04 (1.53–2.70) *** |
Age, years | |||||
<65 | 198 | 81 (40.9) | 1 | 62 (31.3) | 1 |
≥65 | 117 | 78 (66.7) | 1.71 (1.36–2.13) *** | 56 (47.9) | 1.51 (1.13–2.01) ** |
C-reactive protein, mg/L | |||||
≤8.0 | 117 | 51 (43.6) | 1 | 30 (25.6) | 1 |
>8.0 | 198 | 108 (54.5) | 1.46 (1.12–1.90) ** | 88 (44.4) | 1.87 (1.31–2.66) *** |
Anti-CCP2 status | |||||
Negative | 190 | 85 (44.7) | 1 | 59 (31.1) | 1 |
Positive | 125 | 74 (59.2) | 1.44 (1.14–1.80) ** | 59 (47.2) | 1.74 (1.31–2.33) *** |
RF ≥40 IU/ml | |||||
Negative | 176 | 76 (43.2) | 1 | 51 (29.0) | 1 |
Positive | 139 | 83 (59.7) | 1.51 (1.20–1.90) *** | 67 (48.2) | 2.02 (1.50–2.72) *** |
Anti-Sa status | |||||
Negative | 246 | 110 (44.7) | 1 | 76 (30.9) | 1 |
Positive | 69 | 49 (71.0) | 1.72 (1.38–2.14) *** | 42 (60.9) | 2.22 (1.69–2.92) *** |
RF or anti-CCP2 positive | |||||
Negative | 157 | 67 (42.7) | 1 | 44 (28.0) | 1 |
Positive | 158 | 92 (58.2) | 1.53 (1.21–1.94) *** | 74 (46.8) | 2.02 (1.47–2.76) *** |
14-3-3η ≥0.50 ng/ml and age ≥65 years | |||||
Both negative | 117 | 34 (29.1) | 1 | 24 (20.5) | 1 |
One positive | 164 | 98 (59.8) | 2.35 (1.71–3.23) *** | 72 (43.9) | 2.40 (1.61–3.57) *** |
Both positive | 34 | 27 (79.4) | 2.96 (2.07–4.24) *** | 22 (64.7) | 3.46 (2.21–5.42) *** |
14-3-3η ≥0.50 and C-reactive protein >8.0 mg/L | |||||
Both negative | 73 | 28 (38.4) | 1 | 16 (21.9) | 1 |
One positive | 171 | 80 (46.8) | 1.25 (0.88–1.76) | 56 (32.7) | 1.58 (0.97–2.58) |
Both positive | 71 | 51 (71.8) | 2.21 (1.58–3.09) *** | 46 (64.8) | 3.48 (2.17–5.56) *** |
14-3-3η ≥0.50 ng/ml and anti-CCP2 | |||||
Both negative | 163 | 68 (41.7) | 1 | 45 (27.6) | 1 |
One positive | 64 | 34 (53.1) | 1.4 (1.04–1.89) * | 27 (42.2) | 1.74 (1.19–2.54) ** |
Both positive | 88 | 57 (64.8) | 1.7 (1.32–2.20) *** | 46 (52.3) | 2.27 (1.62–3.16) *** |
14-3-3η ≥0.50 ng/ml and RF | |||||
Both negative | 165 | 69 (41.8) | 1 | 44 (26.7) | 1 |
One positive | 46 | 23 (50.0) | 1.31 (0.93–1.86) | 21 (45.7) | 1.80 (1.19–2.72) ** |
Both positive | 104 | 67 (64.4) | 1.68 (1.32–2.15) *** | 53 (51.0) | 2.32 (1.67–3.22) *** |
14-3-3η ≥ 0.50 ng/ml and anti-Sa | |||||
Both negative | 185 | 75 (40.5) | 1 | 51 (27.6) | 1 |
One positive | 76 | 45 (59.2) | 1.36 (1.03–1.79) * | 32 (42.1) | 1.64 (1.15–2.34) ** |
Both positive | 54 | 39 (72.2) | 2.02 (1.57–2.59) *** | 35 (64.8) | 2.80 (2.04–3.85) *** |
14-3-3η ≥ 0.50, “RF and/or anti-CCP2” | |||||
Both negative | 152 | 64 (42.1) | 1 | 41 (27) | 1 |
One positive | 110 | 71 (64.5) | 1.23 (0.87–1.74) | 57 (51.8) | 1.59 (1.04–2.44) * |
Both positive | 53 | 24 (45.3) | 1.71 (1.33–2.19) *** | 20 (37.7) | 2.34 (1.67–3.27) *** |
14-3-3η ≥ 0.50, Age ≥65, C-reactive protein >8.0 | |||||
All negative | 43 | 11 (25.6) | 1 | 7 (16.3) | 1 |
Only C-reactive protein positive | 74 | 23 (31.1) | 1.25 (0.67–2.32) | 17 (23.0) | 1.54 (0.71–3.36) |
Only 14-3-3η positive | 34 | 16 (47.1) | 1.87 (0.97–3.60) | 10 (29.4) | 2.18 (0.94–5.06) |
Only age positive | 30 | 17 (56.7) | 2.41 (1.31–4.43) ** | 9 (30.0) | 2.06 (0.86–4.89) |
Only C-reactive protein and age positive | 53 | 34 (64.2) | 2.97 (1.71–5.18) *** | 25 (47.2) | 3.27 (1.59–6.71) ** |
Only 14-3-3η and C-reactive protein- positive | 47 | 31 (66.0) | 3.21 (1.85–5.59) *** | 28 (59.6) | 4.65 (2.33–9.29) *** |
Only 14-3-3η and age-positive | 10 | 7 (70.0) | 2.22 (1.02–4.84) * | 4 (40.0) | 2.47 (0.85–7.17) |
All positive | 24 | 20 (83.3) | 3.90 (2.25–6.78) *** | 18 (75.0) | 5.49 (2.73–11.08) *** |
Baseline 14-3-3η serum protein levels identify patients with refractory disease over 5 years
Elevated 14-3-3η protein levels during follow up predict more rapid radiographic progression over the following years, even in patients in SDAI remission
Elevated 14-3-3η serum levels improve outcome prediction associated with positive RA-associated antibodies, CRP and older age
Baseline variables | 14-3-3η | 14-3-3η | 14-3-3η | Anti-CCP2 | Anti-CCP2-positive | RF | RF positive | Age (years) | Age ≥65 years | BMI ≥30 |
---|---|---|---|---|---|---|---|---|---|---|
≥0.19 | ≥0.50 | |||||||||
14-3-3η | 1 | |||||||||
14-3-3η ≥ 0.19 | 0.865 *** | 1 | ||||||||
14-3-3η ≥ 0.50 | 0.833 *** | 0.808 *** | 1 | |||||||
Anti-CCP2 | 0.529 *** | 0.515 *** | 0.530 *** | 1 | ||||||
Anti-CCP2-positive | 0.529 *** | 0.524 *** | 0.539 *** | 0.849 *** | 1 | |||||
RF | 0.716 *** | 0.659 *** | 0.731 *** | 0.624 *** | 0.638 *** | 1 | ||||
RF positive | 0.669 *** | 0.616 *** | 0.679 *** | 0.616 *** | 0.661 *** | 0.927 *** | 1 | |||
Anti-Sa positive | 0.409 *** | 0.413 *** | 0.437 *** | 0.527 *** | 0.519 *** | 0.500 *** | 0.481 *** | |||
Age (years) | -0.140 * | -0.118 * | -0.087 | -0.033 | -0.085 | -0.069 | -0.104 | 1 | ||
Age ≥65 years | -0.151 ** | -0.131 * | -0.103 | -0.040 | -0.095 | -0.071 | -0.099 | 0.836 *** | 1 | |
BMI ≥30 | -0.028 | 0.042 | 0.007 | -0.031 | -0.013 | -0.014 | -0.039 | -0.06 | -0.024 | 1 |
Gender (women vs men) | -0.031 | -0.034 | -0.074 | -0.010 | -0.033 | -0.044 | -0.030 | -0.158 ** | -0.072 | 0.000 |
Symptom duration (months) | 0.119 * | 0.127 * | 0.122 * | 0.144 | 0.164 | 0.146 | 0.141 | -0.067 | -0.032 | -0.002 |
Current smoker | 0.137 * | 0.075 | 0.110 * | -0.022 | 0.005 | 0.091 | 0.112 | -0.221 *** | -0.206 *** | -0.068 |
M-HAQ | 0.024 | 0.009 | 0.000 | -0.030 | -0.064 | -0.024 | -0.053 | 0.112 * | 0.032 | 0.138 * |
DAS28-CRP | 0.061 | 0.052 | 0.077 | 0.023 | -0.009 | 0.064 | 0.013 | 0.135 ** | 0.101 | 0.048 |
SDAI | 0.041 | 0.033 | 0.067 | 0.009 | -0.024 | 0.050 | -0.006 | 0.112 ** | 0.089 | 0.02 |
Pain | 0.012 | -0.004 | -0.011 | 0.029 | 0.003 | 0.051 | 0.043 | 0.011 | 0.014 | 0.124 * |
ESR | 0.044 | 0.059 | 0.076 | 0.035 | 0.007 | 0.089 | 0.067 | 0.267 *** | 0.196 *** | 0.115 * |
CRP | 0.000 | -0.011 | 0.023 | 0.014 | 0.021 | 0.015 | -0.009 | 0.151 ** | 0.091 | 0.091 |
CRP >8 | -0.02 | -0.021 | 0.008 | 0.002 | 0.008 | -0.015 | -0.029 | 0.091 | 0.048 | 0.028 |
SJC28 | 0.019 | 0.010 | 0.055 | -0.019 | -0.059 | 0.036 | 0.000 | 0.094 | 0.084 | -0.043 |
TJC28 | 0.082 | 0.080 | 0.103 | 0.008 | -0.022 | 0.065 | 0.005 | 0.124 * | 0.102 | 0.009 |
Total SvH score | 0.036 | 0.051 | 0.049 | 0.009 | 0.024 | 0.026 | -0.005 | 0.491 *** | 0.391 *** | 0.013 |
SvH erosion score | 0.04 | 0.035 | 0.052 | 0.021 | 0.049 | 0.050 | 0.022 | 0.360 *** | 0.287 *** | 0.02 |
GLM | ΔSvH estimate (SE) | ΔErosion estimate (SE) |
---|---|---|
14-3-3η | 0.098 (0.045) * | 0.088 (0.033) ** |
Age (years) | 0.106 (0.017) *** | 0.056 (0.013) *** |
Anti-CCP2 | 0.003 (0.002) | 0.001 (0.002) |
RF | 0.000 (0.001) | 0.000 (0.001) |
Anti-Sa positive | 3.104 (0.747) *** | 2.878 (0.543) *** |
CRP | 0.032 (0.008) *** | 0.025 (0.006) *** |
GEE | ΔSvH ≥5 RR (95 % CI) | ΔErosion ≥5 RR (95 % CI) |
14-3-3η ≥0.50 ng/ml | 2.176 (1.193–3.970) * | 2.276 (1.448–3.577) *** |
Age ≥65 years | 2.680 (1.859–3.864) *** | 2.751 (1.760–4.301) *** |
Anti-CCP2-positive | 1.048 (0.696–1.577) | 1.134 (0.635–2.025) |
RF-positive | 1.191 (0.739–1.921) | 1.689 (1.042–2.738) * |
Anti-Sa-positive | 1.537 (0.708–3.335) | 2.507 (1.348–4.659) ** |
CRP >8.0 mg/L | 1.425 (1.112–1.826) ** | 1.834 (1.304–2.578) *** |
14-3-3η ≥0.50 * age ≥65 years | 0.677 (0.396–1.156) |
Not included
|
14-3-3η ≥0.50 * RF-positive | 0.724 (0.386–1.358) | 0.552 (0.310–0.983) * |
14-3-3η ≥0.50 * anti-Sa positive | 0.898 (0.470–1.717) | 0.400 (0.204–0.786) ** |
Age ≥65 * anti-CCP2 positive | 0.899 (0.507–1.596) | 0.692 (0.351–1.365) |
Age ≥65 * anti-Sa positive | 0.593 (0.345–1.017) |
Not included
|
RF-positive * anti-Sa positive | 1.256 (0.607–2.597) |
Not included
|
Anti-CCP2-positive * anti-Sa positive |
Not included
| 0.856 (0.424–1.728) |