Autoantibodies in rheumatoid arthritis: association with severity of disease in established RA
Autoantibodies in rheumatoid arthritis: association with severity of disease in established RA
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DOI：
10.1007/s10067-006-0275-5
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发表时间：
2007-02-01
影响因子：
3.4
通讯作者：
Aggarwal, Amita
中科院分区：
文献类型：
--
作者：
Agrawal, Sumeet;Misra, Ramnath;Aggarwal, Amita
简介：类风湿性关节炎 (RA) 的自身抗体对于诊断和预后都很有用。最近表明，针对瓜氨酸抗原的抗体可以预测 RA 的发展以及早期关节炎的不良结果。关于他们在已建立的 RA 中的作用的数据有限。我们研究了 RA 中各种自身抗体与其严重程度的关系。材料和方法：总共招募了 129 名患有 RA 的患者，收集血清并储存在 -70 摄氏度下。收集有关侵蚀、畸形和关节外特征的数据。使用比浊法测量 IgM 类风湿因子 (RF)，超过 20 U 的值被认为是阳性。通过酶联免疫吸附测定 (ELISA) 测量 IgA RF，高于正常健康对照平均值 +/- 2 SD 的值被视为阳性。以大鼠食管为底物，通过间接免疫荧光法检测抗角蛋白抗体（AKA）。通过商业 ELISA 测量抗环瓜氨酸肽 (CCP) 抗体，超过 5 U 的值被认为是阳性。结果：各种自身抗体的患病率分别为：IgM RF 82.2%、抗CCP抗体82.2%、AKA 51.9%、抗IgA RF 45%。抗CCP抗体与IgM RF的一致率为83%，与AKA的一致率为68%，与IgA RF的一致率为60.5%。除一名 AKA 阳性患者外，所有患者的抗 CCP 抗体均呈阳性。 IgM RF、AKA 和抗 CCP 抗体的存在与关节糜烂和畸形相关。没有一种抗体与关节外特征的存在有任何关联。未发现 IgA RF 与糜烂、畸形或关节外特征相关。在 23 名血清阴性 RA 患者中，11 名抗 CCP 抗体阳性，6 名 AKA 阳性。抗 CCP 抗体的存在与畸形的存在相关 (p < 0.05)。结论：大多数已确诊的 RA 患者（包括血清阴性患者）中存在抗 CCP 抗体。除了 IgM RF 等传统标记物之外，抗 CCP 和 AKA 都与严重糜烂性疾病相关。
Introduction: Autoantibodies in rheumatoid arthritis (RA) are useful both for diagnosis and prognosis. Antibodies directed against citrullinated antigens have recently been shown to predict development of RA as well as poor outcome in early arthritis. Data on their role in established RA is limited. We studied the association of various autoantibodies in RA with its severity. Materials and methods: A total of one hundred and twenty nine-patients with established RA was enrolled and sera were collected and stored at -70 degrees C. Data regarding erosions, deformities, and extra-articular features were collected. IgM rheumatoid factor (RF) was measured using nephelometry and value above 20 U was considered positive. IgA RF was measured by enzyme-linked immunosorbent assay (ELISA) and value above the mean +/- 2 SD of normal healthy control was taken as positive. Anti-keratin antibody (AKA) was detected by indirect immunofluorescence assay using rat esophagus as substrate. Anti-cyclic citrullinated peptide (CCP) antibodies were measured by commercial ELISA and a value above 5 U was considered as positive. Results: The prevalence of various autoantibodies was: IgM RF 82.2%, anti-CCP antibodies 82.2%, AKA 51.9%, and anti IgA RF 45%. The concordance rate of anti-CCP antibodies with IgM RF was 83%, with AKA 68%, and with IgA RF 60.5%. All but one patient positive for AKA were positive for anti-CCP antibodies. The presence of IgM RF, AKA, and anti-CCP antibody was associated with joint erosions and deformities. None of the antibodies had any association with presence of extraarticular features. No association of IgA RF was seen with erosions, deformities, or extra-articular features. Among 23 seronegative RA patients, 11 were positive for anti-CCP antibodies and 6 were AKA positive. The presence of antiCCP antibodies was associated with presence of deformities (p < 0.05). Conclusion: Anti- CCP antibodies are present in majority of patients with established RA including seronegative patients. Both anti-CCP and AKA, in addition to conventional marker like IgM RF, are associated with severe erosive disease.