Ann Rheum Dis 1999;58:42-48 ( January )

Extended reports

Anti-perinuclear factor compared with the so called "antikeratin" antibodies and antibodies to human epidermis filaggrin, in the diagnosis of arthritides Christian Vincent,^a Filip de Keyser,^b Christine Masson-Bessière,^a Mireille Sebbag,^a Eric M Veys,^b Guy Serre^a

^a Department of Biology and Pathology of the Cell, INSERM CJF 96-02, IFR 30, Purpan Medical School, University of Toulouse III, Toulouse, France, ^b Department of Rheumatology, Gent Hospital, Gent, Belgium

Correspondence to: Dr C Vincent, Laboratoire de Biologie Cellulaire et Cytologie, Hôpital Purpan, Place du Dr Baylac, 31059 Toulouse cedex, France.

Accepted for publication 23 September 1998.

OBJECTIVEAntiperinuclear factor (APF), "antikeratin antibodies" ("AKA"), and antibodies to human epidermis filaggrin (AFA), are highly specific serological markers of rheumatoid arthritis (RA), which recognise epitopes on various isoforms of (pro)filaggrin. It was proposed that these antibodies are globally named antifilaggrin autoantibodies. Here the diagnostic value of the detection of each one is compared and the overlap between the three tests evaluated.
METHODS492 serum samples were tested, including 279 RA serum samples, taken from patients in France and Belgium. APF and "AKA" titres were estimated by indirect immunofluorescence, and AFA titres by immunoblotting on filaggrin enriched human epidermis extracts.
RESULTSBy a convenient choice of the positivity thresholds, the diagnostic sensitivity and specificity of the tests were shown to be similar (0.52 and 0.97, respectively). Although the antibody titres were strongly correlated, the associations APF-AFA or AFA-"AKA" permitted more than 52% or 55% of RA to be diagnosed, with a specificity of 0.99.
CONCLUSIONAPF, "AKA", and AFA detection have a similar diagnostic value. However, because the three tests do not totally overlap, associating APF with "AKA" or AFA with "AKA" can improve diagnostic sensitivity. None of the three antigens used bear all the epitopes recognised by anti-filaggrin autoantibodies.

Keywords: rheumatoid arthritis; antifilaggrin autoantibodies; antiperinuclear factor; antikeratin antibodies

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© 1999 by Annals of the Rheumatic Diseases
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