RESEARCH - RF and anti-CCP are associated with severe extra-articular

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Ann Rheum Dis. 2006 Aug 10; [Epub ahead of print]

Rheumatoid factor and antibodies to cyclic citrullinated peptides are

associated with severe extra-articular manifestations in rheumatoid

arthritis.

Turesson C, sson LT, Sturfelt G, Matteson EL, Mathsson L, Ronnelid J.

Malmo University Hospital, Sweden.

OBJECTIVE: To study antibodies against cyclic citrullinated peptides

(anti-CCP) and rheumatoid factor (RF) in patients with active, severe

extra-articular rheumatoid arthritis (ExRA) compared to non-extra- articular

rheumatoid arthritis (RA) controls. METHODS: Thirty-five consecutive

patients with severe ExRA manifestations according to predefined criteria

were studied. Seventy patients with RA but no ExRA manifestations,

individually matched for age, sex and disease duration, served as controls.

Patients were included when ExRA was diagnosed, before any new treatment was

started. Anti-CCP antibodies were detected with ELISA, RF was quantified

using nephelometry, and anti-nuclear antibodies (ANA) were investigated

using indirect immune fluorescence. RESULTS: Anti-CCP antibodies were

detected in 77 % of ExRA cases vs 56 % of non-ExRA controls (p=0.03).

Anti-CCP levels also tended to be higher in patients with ExRA (p=0.09). RF

was detected in 94 % vs 71 % of cases and controls, respectively (p=0.006),

and RF levels were higher in ExRA cases [Median 245 IU/mL; Interquartile

range (IQR): 94-604 vs median 73 IU/mL; IQR: not detected-165; p=0.0002].

Levels and occurrence of ANA did not differ between ExRA and controls.

Patients with ExRA had higher swollen joint counts and CRP levels, but there

were no correlations between anti- CCP or RF levels and these measures

within the ExRA group.

CONCLUSION: RF is strongly associated with severe ExRA manifestations in

patients with RA, and a similar but weaker association exists for anti-CCP

antibodies. This suggests a role for RF and anti-CCP in the pathogenesis of

ExRA.

PMID: 16901955

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6901955

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