Positive anti-CCP Antibodies Research Articles

FRI0146 Levels of ultrasensitive troponin and nt-probnp in rheumatoid arthritis

BackgroundPatients with rheumatoid arthritis (RA) experience premature mortality that is largely due to cardiovascular disease (CVD). Selective biomarkers have been proposed for CVD prediction. Indeed, ultrasensitive troponin (hs-cTn), a biomarker...

AB0511 Rituximab in rheumatoid arthritis – interim analysis of the non-interventional bridging study

ObjectivesThe BRIDGING study collects clinical routine data on the efficacy and safety of rituximab (RTX) in patients suffering from severe active rheumatoid arthritis (RA).MethodsBRIDGING is a prospective, non-interventional study with...

THU0315 Rhupus’ Arthritis - An MRI and Ultrasound Perspective

BackgroundThe limited application of Ultrasound(US) and MRI to date in SLE is revealing a higher percentage of erosive disease than previous estimates1. Such erosive arthropathy in lupus when associated with...

AB0256 Sex difference in response to rituximab in rheumatoid arthritis patients

BackgroundIdentification of predictors of clinical response to biologic therapy is a key issue in RA in the current era where the number of new biologic targets and related therapies for...

FRI0255 The 158vv fcgamma receptor 3a genotype is associated with response to rituximab in rheumatoid arthritis: results of an italian multicentre study

BackgroundReceptors for IgG allow antibody-dependent cell cytotoxicity, and the polymorphism 158V/F (rs396991) of the Fc fragment of IgG type 3A (FCG3A) was investigated as a genetic factor influencing disease response...

AB0754 Icg-enhanced fluorescence optical imaging detects typical inflammatory changes in asymptomatic subjects with elevated rheumatoid factor or anti-ccp antibodies

BackgroundIn patients with rheumatoid arthritis (RA) anti-CCP antibodies have been found many years before clinical presentation of active disease (1,2). Elevated rheumatoid factor (RF) in healthy subjects increases the long...

AB0355 Anti-CCP antibodies in patients with rheumatologic complaints without rheumatoid arthritis: A prospective cohort in a tertiary care center

BackgroundThe presence of anti-CCP antibodies has been shown to be highly specific for rheumatoid arthritis (RA). Testing for anti-CCP antibodies has grown in popularity and has become widely available. Testing...

Influence of interleukin-4 gene polymorphisms and interleukin-4 serum level on susceptibility and severity of rheumatoid arthritis in Egyptian population

BackgroundRheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease in which interleukin-4 (IL-4) plays an important role. This study aimed to investigate the influence of IL-4 variable number of tandem repeats (VNTRs) and IL-4-590 promoter polymorphisms on RA susceptibility, activity and severity in Egyptian population. Materials and methodsOne hundred and seventy-two RA patients and 172 controls were enrolled in this study. IL-4 VNTR and IL-4-590 promoter polymorphisms were genotyped using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). Serum IL-4 and anti-cyclic citrullinated peptides (anti-CCPs) antibody concentrations were measured by enzyme linked immunosorbent assay (ELISA). ResultsSubjects with IL-4-590 TT genotype were significantly more likely to develop RA. IL-4 VNTR 1/1 genotype, IL-4-590 TT and CT genotypes were significantly more associated with erosive RA and positive anti-CCP antibody. RA severity parameters were significantly increased, while, IL-4 level was significantly decreased in RA patients with IL-4 VNTR 1/1 and IL-4-590 TT genotypes. Only patients with IL-4-590 TT genotype showed a significant increase of all RA activity parameters. ConclusionIL-4 VNTR and IL-4-590 promoter polymorphisms may be helpful for assessing RA severity in Egyptian population. Moreover, IL-4-590 promoter polymorphism may be associated with increased risk and activity of RA.

Anti-cyclic citrullinated peptide (anti-CCP) antibody in juvenile idiopathic arthritis (JIA): Correlations with disease activity and severity of joint damage (a multicenter trial)

ObjectivesTo determine the presence of anti-CCP antibodies in children with JIA and to correlate its levels with Juvenile Arthritis Disease Activity Score (JADAS) and Sharp/Van der Heijde Score. MethodsThe study population comprised 54 cases, with 29 patients (53.7%) who had polyarticular onset, 19 (35.2%) had pauciarticular onset and six (11.1%) had systemic onset JIA. All patients were subjected to complete clinical examination, assessment of disease activity by JADAS-27 (ESR), and radiological damage by Sharp/Van der Heijde Score. Laboratory investigations included a complete blood count, ESR first hour, ANA, IgM Rheumatoid factor (RF) and serum anti-CCP2, and were used for further correlations. ResultsRF was positive in 14 (25.9%) patients and anti-CCP antibodies were positive in 13 (24.1%) patients, 12 of whom had polyarticular onset. There were significant differences between groups relative to RF (F=8.577, P=0.001) and anti-CCP antibodies (F=4.845, P=0.012) being higher in JIA patients with polyarticular onset compared to other subsets of JIA patients. The mean total of the Sharp/Van der Heijde Score was significantly higher among polyarticular-JIA patients with positive anti-CCP antibodies compared to those negative for anti-CCP antibodies (P=0.05). Anti-CCP positively correlated with CRP (r=0.521, P<0.001) and Sharp/Van der Heijde Score (r=0.457, P<0.001). ConclusionAnti-CCP antibodies were prevalent among JIA patients with polyarticular patterns compared to other disease patterns. Anti- CCP positively and significantly correlated with Sharp's score and CRP levels. Given that anti-CCP may be influential in the choice of the best therapeutic strategy in JIA with polyarticular pattern of onset.

Lung disease with anti-CCP antibodies but not rheumatoid arthritis or connective tissue disease

We sought to characterize a novel cohort of patients with lung disease, anti-cyclic citrullinated peptide (CCP) antibody positivity, without rheumatoid arthritis (RA) or other connective tissue disease (CTD). The study sample included 74 subjects with respiratory symptoms, evaluated January 2008-January 2010 and found to have a positive anti-CCP antibody but no evidence for RA or other CTD. Each underwent serologic testing, pulmonary physiology testing, and thoracic high-resolution computed tomography (HRCT) scan as part of routine clinical evaluation. The majority of subjects were women, and most were former cigarette smokers. Four distinct radiographic phenotypes were identified: isolated airways disease (54%), isolated interstitial lung disease (ILD) (14%), mixed airways disease and ILD (26%), and combined pulmonary fibrosis with emphysema (7%). This cohort had a predominance of airways disease, either in isolation or along with a usual interstitial pneumonia-pattern of ILD. Among subjects with high-titer anti-CCP positivity (n=33), three developed the articular manifestations of RA during a median follow-up of 449 days. We have described a unique cohort of patients with anti-CCP antibody positivity and lung disease in the absence of existing RA or other CTD. The lung phenotypic characteristics of this cohort resemble those of established RA and a few of these patients have developed articular RA within a short period of follow-up. The implications of a positive anti-CCP antibody among patients with lung disease but not RA are not yet known, but we believe requires further investigation.

No significant change in arterial stiffness in RA after 6 months and 1 year of rituximab treatment

The excess cardiac risk, found in RA has been attributed to biological inflammation. Effective control of inflammation may be of benefit in reducing cardiovascular risk in RA patients. The aim of this study is to investigate the effects of 24 and 52 weeks of rituximab treatment on arterial stiffness and cardiovascular risk factors. Arterial stiffness was measured by augmentation index (AIx) and pulse wave velocity (PWV), and other cardiovascular risk factors (lipid profile, blood pressure) were collected in active RA patients. Thirty-three patients, of whom 29 were females, with a mean age of 60.9 (12.0) years were included. Thirty patients had positive RFs, 27 had positive anti-CCP antibody and 93.9% (n = 31) were erosive. Nineteen patients were non-responders to anti-TNF-α treatments. After rituximab treatment, no change was observed in arterial stiffness, neither after 6 nor after 12 months [PWV 8.1 (3.1) m/s at baseline, 8.1 (2.8) at 6 months, 8.0 (2.7) at 1 year, P = 0.924; and AIx 30.4 (8.2)% at baseline, 28.6 (7.6) at 6 months, 29.4 (6.7) at 1 year, P = 0.216]. Total and low-density lipoprotein cholesterol levels increased significantly but high-density lipoprotein (HDL) and triglyceride levels were unchanged. The atherogenic index (total cholesterol/HDL cholesterol) was increased, but not to a level of significance. No change was found in other cardiovascular risk factors. DAS-28 according to levels of ESR and CRP and biologic inflammation were significantly improved. Arterial stiffness did not improve after 6 and 12 months of rituximab therapy. The treatment had a beneficial effect on biologic inflammation and disease activity, but caused a pro-atherogenic lipid profile.

Evaluating hand in systemic sclerosis

Articular symptoms are common in SSc and joint pain is a frequent presenting feature of this disease. Hand involvement is often the first clinical manifestation of SSc and could be resulted from fibrosis or synovitis or an overlap syndrome with rheumatoid arthritis (RA); though, the latter is a controversy in practice. To define the clues when identifying the nature of the hand arthropathy in SSc. In order to determine the hand arthropathy, serological tests, hand radiography, finger-to-palm (FTP) distance and other clinical features, disease activity and functional scoring parameters were assessed. Twenty-eight consecutive SSc patients and 43 controls (21 rheumatoid arthritis and 22 healthy controls) were included. Radiographic findings in SSc patients were: Erosions 25%, joint space narrowing 17.9%, arthritis 10.7%, radiological demineralisation 42.9%, acro-osteolysis 25%, flexion contracture 28.6% and calcinosis 17.9%. Anti-CCP antibody and RF positivity were as follows: In SSc group: 3 (11%) and 7 patients (25%); In RA group: 13 (62%) and 19 patients (90.5%); In healthy control group: 1 (4%) and 3 persons (13.6%), respectively. Two patients (7.14%) were regarded as RA overlap, whom both had positive RF and positive anti-CCP results and their radiographs revealed arthritis. Seventeen patients (61%) were regarded as SSc arthropathy; all were negative for RF and anti-CCP but revealed nonarthritic radiological findings. (Among them, only one patient had positive anti-CCP result). The remainder (9 patients) had no radiological or serological finding positive for arthropathy. Arthritis was found to have correlation with heart involvement and FTP was correlated with lung involvement. Hand involvement in SSc is a challenge in rheumatology practice; Radiographic testing when evaluated with RF and anti-CCP will be a helpful tool to discriminate SSc arthropathy from RA-SSc overlap. Hand arthropathy should increase the interest in the serious internal organ involvements of SSc.

The relationship between level of anti-CCP, clinical activity and quality of life in patients with psoriatic arthritis

Objectives: Psoriatic arthritis (PsA) is an inflammatory joint disease. The aim of this study was to investigate the titers of Anti-syclic citrullinated protein (anti-CCP antibodies) in PsA and assess their associations with clinical characteristics and quality of life. Materials and methods: Fourty two patients with PsA and 38 healthy control subjects were included. Demographic data and clinical characteristics including age, gender, disease duration, and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-CCP antibodies and rheumatoid factor were assessed. Visual analog scale (VAS), Nottingham Health Profile (NHP) and short form-36 (SF-36) were used to evaluate QOL in both groups. Results: The demographic data of the subjects were not different between the groups. Patients with PsA had higher anti-CCP levels compared to healthy controls (56.3±73.0 U vs. 0.9±0.5 U, respectively, p=0.01) Thirteen (33.3%) patients with PsA had positive anti-CCP, while no anti-CCP positivity was found in the control group (p<0.001). The scores of NHP social isolation, emotional reaction and pain subscales were significantly higher in PsA patients than in control subjects (p<0.05). The scores of physical domains of NHP were not statistically different between groups. There was no statistically significant correlation between the NHP or the SF-36 scores with ESR or CRP levels in PsA group. SF-36 and NHP were found to be significantly correlated with VAS and fatigue (p<0.05). Conclusion: Anti-CCP antibody positivity was significantly higher in patients with PsA and anti-CCP titers were not related to quality of life measures.

Demographic, clinical, and serological features of Turkish patients with rheumatoid arthritis: evaluation of 165 patients

The study was designed to describe demographic, clinical, serological, and radiological characteristics of patients with rheumatoid arthritis (RA) followed-up by a single institution. One hundred sixty-five patients, diagnosed as RA using ACR classification criteria, and followed-up in the rheumatology clinic between December 2005 and January 2010, were enrolled in the study. Of the patients, 125 were female, and 40 were male. Mean age of the patients was 52.5years, and mean duration of the disease was 10.5years. The most frequently involved joints were the wrist (95.2%), MCP (90.9%), and the PIP (92.6%). The knee and hip joint involvement rates were 44.8% and 23.6%, respectively. Patients (50.9%) were detected to have tenosynovitis. Involvement of the elbow joint was shown in 10.9% of the patients. The most common extra-articular manifestations were sicca symptom (40.6%) and carpal tunnel syndrome (35.7%), followed by pulmonary involvement (6.6%), vasculitis (3.6%), and Raynaud's phenomenon (1.2%). Rheumatoid nodules were detected in six patients (3.6%). One patient had Felty syndrome, and another patient had secondary amyloidosis. Patients (90.3%) had positive rheumatoid factor (RF), and 124 patients had positive anti-CCP antibody (75.2%). A more severe clinical course and a higher incidence of erosion, tenosynovitis, and deformities were detected in patients with anti-CCP antibody and positive RF (p = 0.03, p = 0.04, p = 0.01, p = 0.04, respectively). The wrist was the most frequently involved joint in our patients, and the most frequently seen extra-articular manifestation was sicca symptom. Presence of RF and anti-CCP antibody was associated with more severe disease including erosive and destructive arthropathy. Extra-articular involvement and presence of accompanying diseases increase the mortality.

Relationship between Anti-CCP Antibodies and Oxidant and Anti-Oxidant Activity in Patients with Rheumatoid Arthritis

A new group of autoantibodies in Rheumatoid Arthritis (RA), the anti-cyclic citrullinated peptide (anti-CCP) antibodies directed to citrulline-containing proteins, which are of value for the severity of RA. Up to date, the relationship between anti-CCP antibodies and oxidant, anti-oxidant activity in patients with RA has not been elucidated in the previous studies. In this study we aimed to investigate the effect of anti-CCP antibodies in the circulation on whole blood, serum and synovial fluid oxidant and anti-oxidant activity in patients with RA. RA patients with anti-CCP (+) (n=25) and anti-CCP (-) (n=24) were recruited into the study. All patients had a positive rheumatoid factor (RF). The patients who were under treatment with only non-steroidal antiinflammatory drugs (NSAID) at the study time included in the study. Catalase (CAT), Glutathione peroxidase (GSHPx), Myeloperoxidase (MPO) activities and the levels of Malondialdehyde (MDA) were measured in whole blood, serum and synovial fluid in both groups. There were no significant differences in terms of the mean whole blood and serum antioxidative activity (CAT, GSHpx) and the mean blood and serum MDA and MPO values (oxidative activity), between the patients with anti-CCP(+) and those with anti-CCP(-). There was increased synovial oxidant activity (MDA and MPO levels) (p<0.05) in anti-CCP(+) RA patients with or without ESR negativity when compared with anti-CCP(-) RA patients. There was positive correlation between anti-CCP antibody levels and synovial MDA and MPO levels (r=0.435, p<0.05, r=0.563, p<0.05 respectively) in anti-CCP (+) group. In conclusion, anti-CCP antibody positivity seems to be associated with increased synovial fluid oxidant activity (increased MDA and MPO levels) in patients with RA. These conclusions need to be validated in a larger controlled study population.

Anti-CCP antibodies are associated with early age at onset in patients with rheumatoid arthritis

Objectives To determine factors influencing the age at onset of rheumatoid arthritis (RA). Methods A sample of 152 Colombian patients was investigated. Hazard ratios (HRs) that measured the effect size of risk factors on the age at RA onset were computed by using Cox regression models. Results Positive anti-CCP antibodies were associated with an increased risk of early RA onset (HR = 1.60; 95% confidence interval, [1.06, 2.4]), whereas the presence of the protective 70DERAA 74 sequence was associated with a delayed onset (HR = 0.55; [0.33, 0.92]). After controlling for both anti-CCP antibodies and the 70DERAA 74 sequence, the following variables did not influence significantly the age at RA onset: gender, ever cigarette smoking, family RA history, the TNF-308 A polymorphism, HLA shared epitope, and the presence of rheumatoid factor. Conclusion Anti-CCP antibodies and the HLA-DRB1 70DERAA 74 sequence influence the age at onset of RA.

A can of red herrings

Lymphomatoid granulomatosis is a rare disease. Anti-cyclic citrullinated peptide (anti-CCP) antibody is more commonly found in patients with rheumatoid arthritis and less frequently in some of the other rheumatic and non-rheumatic conditions. It is not recognized to be present in lymphoproliferative disease on its own. We report the first case of anti-CCP antibody positivity in lymphomatoid granulomatosis presenting with polyarthritis. This case illustrates the evolving nature of this disease and its characteristics at different stages leading to the challenge of an accurate diagnosis in the setting of a paraneoplastic polyarthritis.

Anti-CCP Antibody and Rheumatoid Factor Positivity in a Case of Tuberculosis Arthritis

Ozet Postpartum spinal osteoporoz (PPSO) gebelikle iliskili osteoporozla karakterize ender gorulen bir durumdur. En sik gorulen semptomlar bel agrisi ve vertebral kompresyon frakturlerine bagli boy kisalmasidir. Gebeligin son doneminde veya dogumdan hemen sonra gorulur. Dogum sonrasi donemde bel agrisi ile basvuran iki olgumuzu sunarak bel agrisi nedenleri icinde nadir gorulen bu duruma dikkat cekmeyi amacladik. (Turk J Rheumatol 2010; 25: 47-9) Anah tar soz cuk ler: Osteoporoz, gebelik, postpartum, bel agrisi

Anti-cyclic citrullinated peptide antibodies in juvenile idiopathic arthritis

Prevalence and clinical significance of anti-cyclic citrullinated peptide (CCP) antibodies in Indian patients with juvenile idiopathic arthritis (JIA). Anti-CCP antibodies were determined by enzyme-linked immunosorbent assay (ELISA) in 78 patients with JIA which included all 3 major subtypes of the disease: pauciarticular, polyarticular afld systemic onset. Values above 5 relative units were taken as positive. Associations between anti-CCP antibodies and clinical and laboratory and radiological parameters were determined. Anti-CCP antibodies were positive in only 2 of 34 (5.9%) patients with pauciarticular JIA and 3 of 17 (17.6%) of systemic,.pnset JIA, whereas it was positive in 13 of 27 (48.1%) of polyarticular JIA patients (p < 0.001). Furthermore, it was seen that among patients with polyarticular JIA, RF-lgM positive patients had higher rate of anti-CCP antibody positivity with 7 of 8 (87.5%) patients having positive anti-CCP antibody (p<0.001). Similarly, patients with erosions (11/19; p<0.001) and deformities (5/-10; p<0.001) were found to have significant association with anti-CCP antibody positivity. Anti-CCP antibodies could be detected more frequently in the sera of JIA patients with severe manifestations like-erosions and deformity. It was also more significantly associated with seropositive polyarticular JIA than other types. It can be presumed from these results that anti-CCP antibodies can be used as a marker to predict severe course of JIA at the onset to guide optimal aggressive therapy.

Predicting the Progression of Palindromic Rheumatism to Rheumatoid Arthritis: The Role of Ultrasonography and Anti-cyclic Citrullinated Peptide Antibodies

We investigated whether sonography and anti-cyclic citrullinated peptide (anti-CCP) antibodies in Chinese patients with palindromic rheumatism (PR) during active episodes are of predictive value for development of rheumatoid arthritis (RA). Clinically involved regions of 84 PR patients during active episodes were examined with ultrasonography using a 6–13 MHz linear transducer. Serum levels of anti-CCP antibodies were determined by enzyme-linked immunosorbent assay. All patients were followed up monthly for 3 years after investigation. Thirteen (15%) of the PR patients had progressed to RA after a mean of 1.4 years (range, 0.4–3.0 years). Of these 13 patients, 11 patients (85%) had sonographic features of synovitis and 8 patients (62%) had a positive anti-CCP antibody test. The absence of sonographic features of synovitis during active episodes provided a very high 3-year predictive value in excluding the possibility of progression to RA for PR patients with a negative anti-CCP antibody test. Both the sonographic findings of synovitis and a positive anti-CCP antibody test were significant predictors for progression of PR to RA within 3 years by backward stepwise logistic regression analysis. Sonographic examination together with an anti-CCP antibody test during active episodes is useful for predicting the progression of PR to RA.