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Abstract
BackgroundTo analyze differences in the recognition of anti-citrullinated peptide/protein antibody (ACPA) citrullinated epitopes and isotypes in patients with palindromic rheumatism (PR) and rheumatoid arthritis (RA).MethodsACPA fine specificities (citrullinated peptides of enolase, fibrin, and vimentin) and isotypes (IgG, IgM, and IgA) were analyzed in 54 patients with longstanding PR and 54 patients with established RA.ResultsCCP2 tested positive in 66.7% of patients with PR and RA. The ACPA distribution of fine specificities and isotypes differed between PR and RA patients. PR patients had a lower frequency of fine ACPA specificities than RA patients, which was significant in the case of a peptide derived from vimentin (PR 24.1% vs. 59.3% RA; p < 0.001). The mean number of ACPA specificities was lower in PR than in RA patients, and only 25.9% of PR patients recognized ≥2 additional specificities compared with 46.3% of RA patients. Significantly less isotype usage, especially IgA, was observed in PR patients.ConclusionThe ACPA immune response differed in patients with PR and RA, with fewer fine specificities and isotype usage in patients with PR. Some patients with PR may have impaired maturation of the B-cell response against citrullinated peptides with no progression to RA.
Highlights
To analyze differences in the recognition of anti-citrullinated peptide/protein antibody (ACPA) citrullinated epitopes and isotypes in patients with palindromic rheumatism (PR) and rheumatoid arthritis (RA)
PR patients had a lower frequency of some IgG ACPA fine specificities than RA patients, which was significant for the two vimentin-derived peptides, p48 vimentin (1.9% RP vs. 14.8% AR, p = 0.03) and, especially, p55 vimentin (PR 24.1% vs. 59.3% RA; p < 0.001) (Table 2)
25.9% of PR patients recognized ≥2 additional IgG ACPA specificities compared with 46.3% of RA patients (p = 0.028) (Table 3)
Summary
To analyze differences in the recognition of anti-citrullinated peptide/protein antibody (ACPA) citrullinated epitopes and isotypes in patients with palindromic rheumatism (PR) and rheumatoid arthritis (RA). A considerable proportion of PR patients have the characteristic autoantibodies found in RA: rheumatoid factor (RF) and/or anti-citrullinated peptide/ protein antibodies (ACPA). Our first description of the high frequency of ACPA in the sera of PR patients [2] has been confirmed by subsequent studies [3,4,5]. The ACPA reactivities observed in serum of patients with PR are citrulline-dependent as occurs in RA [6]. ACPA may precede the onset of clinical RA by several years. Studies show that ACPA may be directed against several citrullinated peptides, with epitope spreading occurring over several years prior to RA onset [9]. The isotype usage of ACPA may differ in the disease phases, with less isotype usage in the preclinical stage [11, 12]
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