RESEARCH - Anti-CCP antibodies distinguish hepatitis B virus-associated arthropathy from concomitant RA in patients with chronic HBV

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J Rheumatol. 2009 Mar 13.

Anti-Cyclic Citrullinated Peptide Antibodies Distinguish Hepatitis B

Virus (HBV)-associated Arthropathy from Concomitant Rheumatoid

Arthritis in Patients with Chronic HBV Infection.

Lim MK, Sheen DH, Lee YJ, Mun YR, Park M, Shim SC.

From the Division of Rheumatology and Division of Gastroenterology,

Department of Internal Medicine; and Department of Preventive

Medicine, Eulji University, Daejeon, South Korea.

OBJECTIVE: To determine whether anti-cyclic citrullinated peptide

(anti-CCP) antibodies, which are a highly specific test for rheumatoid

arthritis (RA), could differentiate between hepatitis B virus

(HBV)-associated arthropathy and concomitant RA in Korean patients

with chronic HBV infection.

METHODS: We investigated 240 patients with HBV infection. Anti-CCP

antibodies were measured by ELISA and rheumatoid factor (RF) by the

latex fixation test. Patient records were reviewed, and a standard

form was used to record all demographic, clinical, and laboratory

characteristics. Patients were divided into 4 groups according to

joint symptoms: asymptomatic, arthralgia, oligoarthritis, and RA. We

categorized liver disease into 3 groups: carrier, chronic hepatitis,

and cirrhosis.

RESULTS: Anti-CCP antibodies and RF were detected in 11 and 28 of 240

patients, respectively. Anti-CCP antibodies were detected in 9 of 10

RA (90%) and 2 of 230 non-RA patients (0.86%). The positive rate for

RF was 90% in RA and 8.3% in non-RA. Eight of 10 RA patients were

positive for both RF and anti-CCP antibodies. RF was detected in 11

patients without joint symptoms, 4 with arthralgia, and 4 with

oligoarthritis, whereas anti-CCP antibodies were found in 1 patient

without joint symptoms and 1 with oligoarthritis. Specificity of

anti-CCP antibody for RA was 99.1%, whereas RF showed 91.7%

specificity (p < 0.0002). We compared the titers and positive

detection rates of anti-CCP antibodies and RF among liver disease

subgroups. There was no significant between-subgroup difference.

CONCLUSION: Measurement of anti-CCP antibodies is better than RF

detection to discriminate HBV-associated arthropathy from concomitant

RA in patients with chronic HBV infection.

PMID: 19286846

http://www.ncbi.nlm.nih.gov/pubmed/19286846

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