Abstract
It is known that anti-citrullinated protein (a-CCP) antibodies and rheumatoid factor (RF) can be present in systemic sclerosis (SSc) patients, particularly with joint involvement. The aim of the study was to assess the prevalence of a-CCP antibodies and immunoglobulin M class (IgM) RF, and the relationships between their presence and joint manifestations in patients with SSc. The study included 100 European Caucasian SSc patients hospitalized consecutively in the Department of Rheumatology and Connective Tissue Diseases (Lublin, Poland). Anti-citrullinated protein antibodies and IgM RF were determined using a commercial enzyme-linked immunosorbent assay (ELISA) test. Anti-citrullinated protein antibodies were found in 10 out of 100 (10%) SSc patients and IgM RF in 71 out of 100 (71%) SSc patients. In the study, 90/100 (90%) SSc patients had joint manifestations (arthralgia or arthritis), 34/100 (34%) had arthritis and 6/100 (6%) had a systemic sclerosis-rheumatoid arthritis (SSc-RA) overlap syndrome. Significantly higher a-CCP antibody levels (p = 0.012), erythrocyte sedimentation rate (ESR) (p = 0.029) and C-reactive protein (CRP) levels (p = 0.020) were observed in the SSc group with arthritis. A significant correlation was found between the group with arthritis and the presence of a-CCP antibodies, and between the arthralgia group and the presence of IgM RF. The prevalence of RF and a-CCP antibodies is relatively high in SSc, and joint involvement occurs frequently. There was a significantly higher prevalence of IgM RF in the group with joint manifestations. About 1/3 of SSc patients had symptoms of arthritis. Arthritis is connected with the presence of a-CCP antibodies, while arthralgia is connected with the presence of IgM RF.
Highlights
Systemic sclerosis (SSc) is a multisystem disorder characterized by vascular damage, immune activation and fibroblast activation, changes which lead to a progressive thickening of the skin with structural and functional abnormalities of different organs
A significant correlation was found between the group with arthritis and the presence of a-CCP antibodies, and between the arthralgia group and the presence of immunoglobulin M class (IgM) rheumatoid factor (RF)
Arthritis is connected with the presence of a-CCP antibodies, while arthralgia is connected with the presence of IgM RF
Summary
Systemic sclerosis (SSc) is a multisystem disorder characterized by vascular damage, immune activation and fibroblast activation, changes which lead to a progressive thickening of the skin with structural and functional abnormalities of different organs. Musculoskeletal involvement is present in 24–97% of SSc patients.[1,2,3] A more common manifestation is arthralgia, whereas arthritis is rare.[4,5] Hand involvement is often the first clinical manifestation of SSc.[6,7] Symmetrical polyarthritis similar to rheumatoid arthritis (RA) can be found in SSc, but it characterizes a systemic sclerosis-rheumatoid arthritis (SSc-RA) overlap syndrome.[2,8,9,10] In some cases, arthritis in the course of SSc and SSc-RA overlap syndrome can be very difficult to distinguish. It is known that anti-citrullinated protein (a-CCP) antibodies and rheumatoid factor (RF) can be present in systemic sclerosis (SSc) patients, with joint involvement
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