Postmenopausal women with rheumatoid arthritis (RA) who tested positive for an antibody called anti-cyclic citrullinated peptide (anti-CCP) were up to two and a half times more likely to die than women without the antibody, according to a new research published online recently in Arthritis & Rheumatology.

This is the first large, long-term study to show a correlation between increased mortality and anti-CCP antibodies – sometimes called anti-citrullinated protein antibodies (ACPA). Previous studies have shown RA patients in general have a 1.5 increased risk of death than people without RA – due in great part to cardiovascular disease.

Anti-CCP antibodies are the most specific markers for RA, meaning that they are rarely present in people without RA. By contrast, another marker for RA called rheumatoid factor (RF) may be present in people who have diseases other than RA.

“This is a study that clearly shows this disease, if not treated appropriately and aggressively, can lead to excess mortality, and if you have the anti-CCP antibody you need to be treated and followed very carefully so you can try to prevent early death,” explains senior author Larry Moreland, MD, chief of the division of rheumatology and clinical immunology at the University of Pittsburgh, in Pennsylvania.

For this study, Dr. Moreland and his team looked at levels of anti-CCP, RF and a third marker of possible autoimmune disease called antinuclear antibodies (ANA) in 9,988 women with self-reported RA. These women were part of a much larger study called the Women’s Health Initiative (WHI), which enrolled participants between 1993 and 1997. Participants in this subgroup had an average age of 65 at the start of the study; 65 percent were white, 25 percent were black and 10 percent were Hispanic.

During the 10 years of follow-up, 13 percent of the women died. Cardiovascular disease (including coronary heart disease and stroke) and cancer were the main causes. After taking into account other factors (such as age, smoking and diabetes status, and the use of certain medications) women who were anti-CCP positive were up to 2.8 times more likely to die than those who were not anti-CCP positive.