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Different properties of ACPA and IgM-RF derived from a large dataset: further evidence of two distinct autoantibody systems

Jennie Ursum1, Wouter H Bos1, Rob J van de Stadt1, Ben AC Dijkmans2 and Dirkjan van Schaardenburg12*

Author Affiliations

1 Jan van Breemen Institute, Dr. Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands

2 VU University Medical Centre, Postbus 7057, 1007 MB Amsterdam, The Netherlands

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Arthritis Research & Therapy 2009, 11:R75  doi:10.1186/ar2704

See related editorial by Valesini and Alessandri,

Published: 21 May 2009



The aim of this study was to examine seroconversion and the relationship with age and inflammation of autoantibodies in a large group of patients attending an outpatient rheumatology clinic.


Levels of antibodies to citrullinated proteins/peptides (ACPAs) and IgM rheumatoid factor (IgM-RF) were determined in 22,427 samples collected from 18,658 patients. The diagnosis was derived from a diagnosis registration system. The degree of seroconversion in repeated samples and the correlation of levels with age and inflammatory markers were determined for ACPA and IgM-RF in rheumatoid arthritis (RA) and non-RA patients.


Seventy-one percent of RA patients (n = 1,524) were ACPA-positive and 53% were IgM-RF-positive; in non-RA patients (n = 2,245), the corresponding values were 2% and 4%, respectively. In patients with at least two samples (n = 3,769), ACPA status was more stable than IgM-RF status in RA patients. ACPA- or IgM-RF-negative non-RA patients seldom became positive. ACPA positivity was unrelated to age in both RA and non-RA patients. IgM-RF positivity was unrelated to age in RA patients; however, it increased with age in non-RA patients. The correlation between autoantibody levels and inflammatory markers was low in general and was somewhat higher for IgM-RF than for ACPA.


ACPA status is more stable in time and with increasing age than IgM-RF status, further establishing its role as a disease-specific marker. ACPA and IgM-RF levels are only moderately correlated with markers of inflammation.