Anti-CCP antibodies, rheumatoid factors and anti-keratin antibodies: clinical value in established rheumatoid arthritis.

##plugins.themes.academic_pro.article.sidebar##

Published Mar 3, 2011
Download
pdf
Vol. 89 No. 3 (2011): Issue Mar 2011

##plugins.themes.academic_pro.article.main##

Mohamed Amri
Imen Sfar
Hajer Skhiri
Tarek Dhaouadi
Noura Bel Hadj
Leila Abdelmoula
Rafik Zouari
Khaled Ayed
Yosr Gorgi

Abstract

Background : It is well documented that in early rheumatoid arthritis, anti-CCP antibodies have better diagnostic value than rheumatoid factors and anti-keratin antibodies. However, their role is less well defined in patients with established or long duration disease.
Aim : To evaluate and to compare diagnostic performances of anti- CCP, anti-keratin, IgM and IgA rheumatoid factors in established rheumatoid arthritis.
Methods : In a cross-sectional study, 90 patients with established rheumatoid arthritis and 100 controls were tested for these autoantibodies. The association of these markers with disease activity and severity was investigated. The sensitivity and specificity were calculated for each of four tests, using the clinical diagnosis as the gold standard.
Results : The anti-CCP and IgM rheumatoid factor exhibited the best diagnostic value. None of the tested antibodies had any significant association with the disease activity score (DAS28). After adjustment by multiple linear regression, only anti-CCP positivity was found to be significantly associated with erosive disease.
Conclusion : In long duration rheumatoid arthritis, anti-CCP and IgM rheumatoid factor have similar diagnostic value. However anti- CCP are useful in seronegative patients. They are also a reliable marker of severe erosive disease.

Keywords:

Rheumatoid arthritis, Anti-CCP, Rheumatoid factors, Anti-keratin antibodies

##plugins.themes.academic_pro.article.details##

References

  1. Lee DM, Weinblatt ME. Rheumatoid arthritis. Lancet 2001; 358: 903-11.
  2. NG K, Austin P, Ameratunga R, McQueen F. Role of anticyclic citrullinated peptide 2 assay in long-standing rheumatoid arthritis. APLAR Journal of Rheumatology 2006; 9: 211-5.
  3. Arnett FC, Edworthy SM, Bloch DA et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315-24.
  4. Vallbracht I, Rieber J, Oppermann M, Förger F, Siebert U, Helmke K. Diagnostic and clinical value of anti-cyclic citrullinated peptide antibodies compared with rheumatoid factor isotypes in rheumatoid arthritis. Ann Rheum Dis 2004; 63: 1079- 84.
  5. Meyer O, Fabregas D, Cyna L, Ryckewaert A. Anti-keratin antibodies. A marker of progressive rheumatoid arthritis. Rev Rhum Mal Osteoartic 1986; 53: 601-5.
  6. Greiner A, Plischke H, Kellner H, Gruber R. Association of anticyclic citrullinated peptide antibodies, anti-citrullin antibodies, and IgM and IgA rheumatoid factors with serological parameters of disease activity in rheumatoid arthritis. Ann N Y Acad Sci 2005; 1050: 295-303.
  7. Bas S, Genevay S, Meyer O, Gabay C. Anti-cyclic citrullinated peptide antibodies, IgM and IgA rheumatoid factors in the diagnosis and prognosis of rheumatoid arthritis. Rheumatology 2003; 42: 677-80.
  8. Prevoo ML, Van't Hof MA, Kuper HH, Van Leeuwen MA, Van de Putte LB, Van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995; 38: 44-8.
  9. Zendman AJ, Van Venrooij WJ, Pruijn GJ. Use and significance of anti-CCP autoantibodies in rheumatoid arthritis. Rheumatology 2006; 45: 20-5. Review.
  10. Niewold TB, Harrison MJ, Paget SA. Anti-CCP antibody testing as a diagnostic and prognostic tool in rheumatoid arthritis.QJM 2007; 100: 193-201.
  11. Alexiou I, Germenis A, Ziogas A, Theodoridou K, Sakkas LI. Diagnostic value of anti-cyclic citrullinated peptide antibodies in Greek patients with rheumatoid arthritis. BMC Musculoskelet Disord 2007; 8:37.
  12. Lee DM, Schur PH. Clinical utility of the anti-CCP assay in patients with rheumatic diseases. Ann Rheum Dis 2003; 62: 870-4.
  13. Kroot EJ, De Jong BA, Van Leeuwen MA et al. The prognostic value of anti-cyclic citrullinated peptide antibody in patients with recent-onset rheumatoid arthritis. Arthritis Rheum 2000; 43: 1831-5.
  14. Solanki K, Spellerberg M, Chapman P, Moller P, O'Donnell J. Anti-cyclic citrullinated antibodies: complementary to IgM rheumatoid factor in the early diagnosis of rheumatoid arthritis. N Z Med J 2004; 117: U1097.
  15. Ordeig J, Guardia J. Diagnostic value of anti-keratin antibodies in rheumatoid arthritis. J Rheumatol 1984; 11: 602-4.
  16. Meyer O, Combe B, Elias A et al. Autoantibodies predicting the outcome of rheumatoid arthritis: evaluation in two subsets of patients according to severity of radiographic damage. Ann Rheum Dis 1997; 56: 682-5.
  17. Vasiliauskiene L, Wiik A, Hoier-Madsen M. Prevalence and clinical significance of anti-keratin antibodies and other serological markers in Lithuanian patients with rheumatoid arthritis. Ann Rheum Dis 2001; 60: 459-66.
  18. Agrawal S, Misra R, Aggarwal A. Autoantibodies in rheumatoid arthritis: association with severity of disease in established RA. Clin Rheumatol 2007; 26: 201-4.
  19. Päi S, Päi L, Birkenfeldt R. Correlation of serum IgA rheumatoid factor levels with disease severity in rheumatoid arthritis. Scand J Rheumatol 1998; 27: 252-6.
  20. Turesson C, Jacobsson LT, Sturfelt G, Matteson EL, Mathsson L, Rönnelid J. Rheumatoid factor and antibodies to cyclic citrullinated peptides are associated with severe extra-articular manifestations in rheumatoid arthritis. Ann Rheum Dis 2007; 66: 59-64.
  21. Bas S, Perneger TV, Seitz M, Tiercy JM, Roux-Lombard P, Guerne PA. Diagnostic tests for rheumatoid arthritis: comparison of anti-cyclic citrullinated peptide antibodies, anti-keratin antibodies and IgM rheumatoid factors. Rheumotology 2002; 41: 809-814.
  22. Forslind K, Ahlmén M, Eberhardt K, Hafström I, Svensson B. Prediction of radiological outcome in early rheumatoid arthritis in clinical practice: role of antibodies to citrullinated peptides (anti- CCP). Ann Rheum Dis 2004; 63: 1090-5.
  23. Ronnelid J, Wick MC, Lampa J et al. Longitudinal analysis of citrullinated protein/peptide antibodies (anti-CP) during 5 year follow up in early rheumatoid arthritis: anti-CP status predicts worse disease activity and greater radiological progression. Ann Rheum Dis 2005; 64: 1744-9.
  24. Teitsson I, Withrington RH, Seifert MH, Valdimarsson H. Prospective study of early rheumatoid arthritis. I. Prognostic value of IgA rheumatoid factor. Ann Rheum Dis 1984; 43: 673-678.
  25. Tarkowski A, Nilsson L A. Isotype specific measurement of rheumatoid factor with reference to clinical features of rheumatoidarthritis. J Clin Lab Immunol 1983; 12: 129-35.
  26. Shankar S, Grover R, Handa R. Role of anti cyclic citrullinated peptide antibodies in erosive disease in patients with rheumatoid arthritis. Indian J Med Res 2006; 124: 689-96.
  27. Mewar D, Coote A, Moore DJ et al. Independent associations of anti-cyclic citrullinated peptide antibodies and rheumatoid factor with radiographic severity of rheumatoid arthritis. Arthritis Res Ther 2006; 8: R128.