RESEARCH - Quantifying anti-CCP titer: clinical utility and association with tobacco exposure in patients with RA

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Ann Rheum Dis. 2008 Apr 7

Quantifying Anti-CCP titer: clinical utility and association with

tobacco exposure in patients with rheumatoid arthritis.

Lee DM, R, Hagan EM, Chibnik LB, Costenbader KH Md Mph, Schur PH.

Brigham and Women's Hospital/Harvard Medical School, United States.

OBJECTIVES: To determine the significance of quantitative levels of

antibodies to cyclic citrullinated peptides (anti-CCP) in a population

of patients with rheumatoid arthritis (RA). METHODS: 241 consecutive

sera from patients with RA sent from a large rheumatology clinic for

laboratory testing were selected for precisely quantifying anti-CCP

antibody titers with the anti-CCP2 assay. Patient charts were reviewed

for demographic information, smoking history, clinical diagnosis, RF

titer, radiographic information and other laboratory information (ESR

and CRP). Correlations with anti-CCP titer and RF titer, disease

parameters and smoking history were assessed. RESULTS: We confirm

previous findings that anti-CCP seropositivity is associated with a

higher incidence of erosions in patients with RA (56% vs 20% CCP+ vs

CCP-, kappa=0.297, P<0.0001). We also find a moderate correlation

between anti-CCP titer and RF titer. However, we failed to find

association between anti-CCP titer and presence of erosions, between

anti-CCP titer and CRP or ESR level or between anti-CCP titer and age

or disease duration. Interestingly, we did find a significantly higher

anti-CCP titers in patients with a history of smoking (452 units/ml vs

229 units/ml, smoker vs. non-smoker respectively. P=0.02).

CONCLUSIONS: Although anti-CCP titers were not associated with

clinical parameters of disease, they are increased in RA patients with

exposure to tobacco. In contrast, no elevation in RF was noted in

patients with history of smoking. These observations are consistent

with a pathogenic contribution of smoking to RA and suggest the immune

stimulus for anti-CCP is distinct from that for RF.

PMID: 18390910

http://www.ncbi.nlm.nih.gov/pubmed/18390570

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