Abstract
The objective of this study was to investigate the frequency of antibodies against cyclic citrullinated peptides (anti-CCP) and keratin (AKA) in patients with rheumatoid arthritis (RA) as well as in patients with primary Sjögren’s syndrome (pSS) and Wegener’s granulomatosis (WG), who may present with rheumatoid factor (RF)-positive arthritis. The study group consisted of 46 patients with RA (26 patients were negative for RF), 32 with pSS, 22 with WG, and 40 healthy controls. The RF, anti-CCP, and AKA were detected in serum using the latex agglutination test, enzyme-linked immunosorbent assay, and indirect immunofluorescence, respectively. The agreement between those tests was evaluated by kappa test. No positive result for AKA was detected in pSS and WG patients, and anti-CCP was found in only one patient with pSS. The results of kappa tests were low, varying between 0.25 (RF-anti-CCP) and 0.02 (RF-AKA). The sensitivity and specificity values were 43 and 44% for RF, 65 and 98% for anti-CCP, and 58 and 100% for AKA, respectively, in RA patients. In the RF-negative RA group, AKA was found to have a high frequency (55%) in comparison to anti-CCP (38%). Seropositivity was found to be 87% for any one of the three autoantibodies tested in RA patients. With a higher specificity, values for RA, anti-CCP, and AKA seem to be helpful for the differential diagnosis of patients with RF-positive arthritis, which may include patients with WG and pSS, and screening of all three antibodies may increase the diagnostic performance.
References
Aho K, Palosuo T (2002) Can outcome of early synovitis be predicted by serological tests? Clin Rheumatol 21:97–102
Cordonnier C, Meyer O, Palazzo E et al (1996) Diagnostic value of anti-RA33 antibody, antikeratin antibody, antiperinuclear factor and antinuclear antibody in early rheumatoid arthritis: comparison with rheumatoid factor. Br J Rheumatol 35:620–624
Schellekens GA, Visser H, de Jong BA et al (2000) The diagnostic properties of rheumatoid arthritis antibodies, recognizing a cyclic citrullinated peptide. Arthritis Rheum 43:155–163
Goldbach-Mansky R, Lee J, Mc-Coy A et al (2000) Rheumatoid arthritis associated autoantibodies in patients with synovitis of recent onset. Arthritis Res 2:236–243
Bizzaro N, Mazzanti G, Tonutti E, Villalta D, Tozzoli R (2001) Diagnostic accuracy of the anti-citrulline antibody assay for rheumatoid arthritis. Clin Chem 47:1089–1093
Bas S, Genevay S, Meyer O, Gabay C (2003) Anticyclic citrullinated peptide antibodies IgM and IgA rheumatoid factors in the diagnosis and prognosis of rheumatoid arthritis. Rheumatology 42:677–680
Vincent C, Serre G, Lapeyre F et al (1989) High diagnostic value in rheumatoid arthritis of antibodies to the stratum corneum of rat oesophagus epithelium, so-called “antikeratin antibodies”. Ann Rheum Dis 48:712–722
Saraux A, Berthelot JM, Chales G et al (2002) Value of laboratory tests in early prediction of rheumatoid arthritis. Arthritis Rheum 47:155–165
Zeng X, Ai M, Tian X et al (2003) Diagnostic value of anti-cyclic citrullinated peptide antibody in patients with rheumatoid arthritis. J Rheumatol 30:1451–1455
Maddison PJ (1998) Autoantibody profile. In: Maddison PJ, Isenberg DA, Woo P, Glass DN (eds) Oxford textbook of rheumatology, 2nd edn. Oxford University Press, New York, pp 665–676
Harrison BJ, Symmons DPM, Barrett EM, Silman AJ (1998) The performance of the 1987 ARA classification criteria for rheumatoid arthritis in a population-based cohort of patients with early inflammatory polyarthritis. J Rheumatol 25:2324–2330
Castro-Poltronieri A, Alarcon-Segovia D (1983) Articular manifestations of primary Sjogren’s syndrome. J Rheumatol 10:485
Tzioufas AG, Youinou P, Moutsopoulos HM (1998) Sjogren’s syndrome. In: Maddison PJ, Isenberg DA, Woo P, Glass DN (eds) Oxford textbook of rheumatology, vol II, 2nd edn. Oxford University Press, New York, pp 1301–1317
Hoffman GS, Kerr GS, Leavitt RY et al (1992) Wegener’s granulomatosis: an analysis of 158 patients. Ann Intern Med 116:488–498
Noritake DT, Weiner SR, Bassett LW, Paulus HE, Weisbart R (1987) Rheumatic manifestations of Wegener’s granulomatosis. J Rheumatol 14:949–951
Stone JH, Hoffman GS (2003) Wegener’s granulomatosis and lymphomatoid granulomatosis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH (eds) Rheumatology, vol II, 3rd edn. Elsevier Science, New York, pp 1635–1648
Douglas G, Bird K, Flume P, Silver R, Bolster M (2003) Wegener’s granulomatosis in patients with rheumatoid arthritis. J Rheumatol 30:2064–2069
Youinou P, Le Goff P, Colaco CB et al (1985) Antikeratin antibodies in serum and synovial fluid show specificity for rheumatoid arthritis in a study of connective tissue diseases. Ann Rheum Dis 44:450–454
Dubucquoi S, Solau-Gervais E, Lefranc D et al (2004) Evaluation of anti-citrullinated filaggrin antibodies as hallmarks for the diagnosis of rheumatic diseases. Ann Rheum Dis 63:415–419
Arnett FC, Edworthy SM, Bloch DA et al (1998) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324
Young BJJ, Mallya RK, Leslie RDJ, Clark CJM, Hamblin TJ (1979) Anti-keratin antibodies in rheumatoid arthritis. BMJ 2:97–99
Vittecoq O, Incaurgarat B, Jouen-Beades F et al (2004) Autoantibodies recognizing citrullinated rat filaggrin in an ELISA using citrullinated and non-citrullinated recombinant proteins as antigens are highly diagnostic for rheumatoid arthritis. Clin Exp Rheumatol 135:173–180
Mediwake R, Isenberg DA, Schellekens GA, van Venrooij WJ (2001) Use of anti-citrullinated peptide and anti-RA33 antibodies in distinguishing erosive arthritis in patients with systemic lupus erythematosus and rheumatoid arthritis. Ann Rheum Dis 60:67–68
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Kamali, S., Polat, N.G., Kasapoglu, E. et al. Anti-CCP and antikeratin antibodies in rheumatoid arthritis, primary Sjögren’s syndrome, and Wegener’s granulomatosis. Clin Rheumatol 24, 673–676 (2005). https://doi.org/10.1007/s10067-005-1104-y
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DOI: https://doi.org/10.1007/s10067-005-1104-y