Objective: To analyze the antibody response to native type II collagen in early rheumatoid arthritis (RA), examining the immunoglobulin isotypes, and polypeptide epitopes recognized, in patients followed over a 2-year period from within 6 months of the first occurrence of symptoms.

Methods: Sera from 16 patients were studied, of whom 10 had antibodies to native type II collagen and 6 did not. The clinical and laboratory assessment, carried out initially and at 6 monthly intervals included the number of 1958 ARA criteria fulfilled, Ritchie index, erythrocyte sedimentation rate, rheumatoid factor and radiological assessment. An ELISA was used to measure IgG, IgA and IgM antibodies, and immunoblotting to identify the number and location of epitopes, using polypeptides prepared by cyanogen bromide digestion of human type II collagen.

Results: Antibodies to type II collagen were present in all sequential serum samples for the 10 antibody positive patients. None of the 6 patients who initially lacked antibodies developed them. The antibodies were of IgG isotype in 9, of IgA isotype in 8, and of IgM isotype exclusively in one. At the initial clinical assessment patients with antibodies to collagen were indistinguishable from those without. At 12 and 24 months patients with antibodies fulfilled significantly more ARA criteria than antibody negative patients. The patterns of antibody reactivity to collagen polypeptides by immunoblotting were constant over time but differed from patient to patient.

Conclusion: The presence of an established and persisting IgG antibody response to type II collagen in early RA before cartilage destruction is evident points to a subset of RA, perhaps equivalent to the collagen induced model in animals, in which this immune response is intrinsic to pathogenesis.