The extent of the anti-citrullinated protein antibody repertoire is associated with arthritis development in patients with seropositive arthralgia
The extent of the anti-citrullinated protein antibody repertoire is associated with arthritis development in patients with seropositive arthralgia
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DOI：
10.1136/ard.2010.132662
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发表时间：
2011-01-01
影响因子：
27.4
通讯作者：
Hamann, Dorte
中科院分区：
文献类型：
--
作者：
van de Stadt, Lotte A.;van der Horst, Ann R.;Hamann, Dorte
目的探讨抗瓜氨酸蛋白抗体（anti-cyclic citrulinated protein antibodies，ACPA）在关节炎早期诊断中的特异性，并探讨其与关节炎发生的关系。关节炎的发生定义为随访期间临床检查时存在一个或多个肿胀关节。血清进行了测试，在基线的反应性五瓜氨酸肽来源于纤维蛋白原（三），波形蛋白（一）和α-烯醇化酶（一）和五个相应的精氨酸peptides in a ELISA.Results在所有，69例（28%）发展关节炎的中位数3关节后，中位随访11（IQR 5-20）个月。对每种肽的反应性与关节炎的发展显著相关（p < 0.001）。ACPA库在发生或未发生关节炎的患者之间没有差异。在aCCP阳性患者中，识别两种或更多种瓜氨酸肽的患者更常发生关节炎（p=0.04）。识别的肽的数量与aCCP水平正相关（p < 0.001）。不同的肽之间的交叉反应是minimal.Conclusions关节炎的发展是不相关的识别一个特定的瓜氨酸肽一旦联合投诉。ACPA在某些关节痛患者中的功能有所扩展。高aCCP水平与定性广泛的ACPA库相关。具有扩展ACPA库的患者具有更高的发展关节炎的风险。
Objectives To determine the fine specificity of anti-citrullinated protein antibodies (ACPA) in the early phase of arthritis development, the ACPA repertoire in arthralgia patients and the association with arthritis development were studied.Methods A total of 244 patients with arthralgia positive for anti-cyclic citrullinated peptide antibodies (aCCPs) and/or IgM rheumatoid factor (IgM-RF), without arthritis were included. Development of arthritis was defined as presence of one or more swollen joints at clinical examination during follow-up. Sera were tested at baseline for reactivity to five citrullinated peptides derived from fibrinogen (three), vimentin (one) and alpha-enolase (one) and five corresponding arginine peptides in an ELISA.Results In all, 69 patients (28%) developed arthritis in a median of 3 joints after a median follow-up of 11 (IQR 5-20) months. Reactivity to each peptide was significantly associated with arthritis development (p < 0.001). The ACPA repertoire did not differ between patients who did or did not develop arthritis. Among aCCP-positive patients, patients recognising two or more additional citrullinated peptides developed arthritis more often (p=0.04). The number of recognised peptides was positively associated with the aCCP level (p < 0.001). Crossreactivity between different peptides was minimal.Conclusions Arthritis development is not associated with recognition of a specific citrullinated peptide once joint complaints are present. The ACPA repertoire in some patients with arthralgia is expanded. High aCCP levels are associated with a qualitatively broad ACPA repertoire. Patients with an extended ACPA repertoire have a higher risk of developing arthritis.