Bruno Oliveira, MD, Rheumatology, 07:08PM Sep 14, 2009
This may sound familiar to young Rheumatologists and will give seasoned Rheumatologists a feeling of "I told you so". Here is the scenario: You are seeing a patient with RA, who was previously followed by a retired partner. The patient was diagnosed with RA in the 80's or early 90's and you can't find a RF to speak of. By looking at the patient, you do not see any chronic deformities from RA. The patient has taken the same DMARD for several years. So, you question the diagnosis (as you have been trained to do). You order a RF and anti-CCP and they come back negative. Next, you suggest tapering and discontinuation of the DMARD and next thing you know they come back with horrendous synovitis.
A letter in the Annals of Rheumatic Diseases may shed some light on this phenomenon. The authors reported on their experience with 21 RA patients treated with COBRA-like regimens for 40 weeks. Decreasing levels of RF have been reported in the past, but this report seems to be the first to demonstrate profound decreases in anti-CCP levels as well. (Link to paper)
Patients have asked me if their RF or anti-CCP should be repeated to see if their RA was under remission or good control. I have always answered that this was not necessary because these tests would not necessarily reflect disease activity. Maybe, I wasn't 100% correct in my statement.