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AB1235 Clinical relevance of anti-citrullinated protein antibody for the detection of rheumatoid arthritis in hemodialysis patients
  1. A. Nakashima1,
  2. K. Yamada2,
  3. M. Kawano2
  1. 1Department of Internal Meddicine, Saiseikai Kanazawa Hospital
  2. 2Division of Rheumatology, Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan

Abstract

Background Hemodialysis (HD) patients are considered to be at increased risk for developing rheumatoid arthritis (RA), as a result of immunologic abnormalities caused by this treatment1). Anti-cyclic citrullinated peptide (anti-CCP) antibody testing is particularly useful in the diagnosis of rheumatoid arthritis, with high specificity, especially early in the disease process2).

Objectives To determine this possibility, anti-CCP and other autoantibodies, such as rheumatoid factor (RF) and anti-nuclear antibody (ANA) were evaluated.

Methods We examined 113 hemodialysis patients (64 males and 49 females; mean age 65.2±10.6 years). The duration of hemodialysis was 7.9±7.5 years. The etiologies of ESRD were: aortitis syndrome (n=1), glomerulonephritis (n=36), diabetes mellitus (n=36), benign glomerulosclerosis (n=14), polycystic kidney disease (n=6), drug induced renal failure (n=2), hyperparathyroidism (n=2), hypoplastic kidney (n=1), interstitial nephritis (n=1), pregnancy kidney (n=2), purpura nephritis (n=1), RA (n=1), rapidly progressive glomerulonephritis (n=1), and unknown (n=8). Anti-CCP was measured using enzyme-linked immunosorbent assay (ELISA) with the CCP Ab. ELISA “Cosmic” (Cosmic Corporation, Tokyo, Japan). The normal value for anti-CCP reported by the manufacturer is less than 4.5 U/mL.

Results Mean serum value of Anti-CCP of HD patients was 4.8±24.3 U/ml, and five patients (4.4%) were positive for serum anti-CCP, three of whom showed high titers (64.3, 165.6, and 192.2 U/mL). Two of these patients developed RA after starting HD. Six patients (5.3%) were positive for ANA, and ten patients (8.8%) for RF.

Conclusions Our results indicated that HD patients had increased values of anti-CCP more frequently than the normal population and some of them developed RA. Romic et al3) reported that anti-CCP and RF concentrations were not changed in HD patients, but increased values of anti-CCP were detected in four of fifty-seven HD patients. They did not describe any signs or symptoms in HD patients who showed increased values of anti-CCP and suggested that HD is not likely to be a trigger for development of RA. Contrary to these findings, our results suggested that HD might indeed trigger RA. Future prospective studies are needed to determine if anti-CCP is an early predictor of RA in HD patients who might be at greater risk of developing this condition.

  1. Gagnon RF, Shuster J, Kaye M. Auto-immunity in patients with end-stage renal disease maintained on hemodialysis and continuous ambulatory peritoneal dialysis. J Clin Lab Immunol 1983; 11, 155-158.

  2. Niewold TB, Harrison MJ, Paget SA. Anti-CCP testing as a diagnostic and prognostic tool in rheumatoid arthritis. QJM 2007; 100, 193-201.

  3. Romic Z, Unic A, Derek L et al. Anti-citrullinated protein antibody and rheumatoid factor in patients with end-stage renal disease. Clin Chem Lab Med 2009; 47, 959-962.

Disclosure of Interest None Declared

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