RESEARCH - Autoantibodies in RA: association with severity of disease in established RA

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Clin Rheumatol. 2006 Mar 30; [Epub ahead of print]

Autoantibodies in rheumatoid arthritis: association with severity of disease

in established RA.

Agrawal S, Misra R, Aggarwal A.

Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical

Sciences, Lucknow, India, amita@....

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 extra-articular 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

anti-CCP 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.

PMID: 16572283

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16572283

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