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AB0189 Anti-Modified Protein Antibody Response Pattern Influences The Risk for Disease Relapse in Rheumatoid Arthritis Patients Tapering Disease Modifying Anti-Rheumatic Drugs
  1. C. Figueiredo1,
  2. H. Bang2,
  3. J.F. Cobra3,
  4. M. Englbrecht4,
  5. A.J. Hueber4,
  6. J. Haschka5,
  7. B. Manger4,
  8. A. Kleyer4,
  9. M. Reiser4,
  10. S. Finzel6,
  11. H.-P. Tony7,
  12. S. Kleinert8,
  13. J. Wendler8,
  14. F. Schuch8,
  15. M. Ronneberger8,
  16. M. Feuchtenberger9,
  17. M. Fleck10,
  18. K. Manger11,
  19. W. Ochs12,
  20. M. Schmitt-Haendle12,
  21. H.-M. Lorenz13,
  22. H. Nuesslein14,
  23. R. Alten15,
  24. J.C. Henes16,
  25. K. Krueger17,
  26. J. Rech4,
  27. G. Schett4
  1. 1Universiy of Erlangen-Nuremberg, Erlangen
  2. 2Orgentec Diagnostica, Mainz, Germany
  3. 3Instituto de Reumatologia de Sao Paulo, Sao Paulo, Brazil
  4. 4University of Erlangen-Nuremberg, Erlangen, Germany
  5. 5Medical Department II, St. Vincent Hospital, the VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria
  6. 6University Medical Center Freiburg, Rheumatology and Clinical Immunology, Freiburg
  7. 7Department of Internal Medicine 2, University of Wuerzburg, Würzburg
  8. 8Rheumatology Practice, Erlangen
  9. 9Clinic Burghausen, Rheumatology Practice and Department of Internal Medicine 2, Burghausen
  10. 10Department of Rheumatology and Clinical Immunology, Asklepios Medical Center, Regensburg
  11. 11Rheumatology Practice, Bamberg
  12. 12Rheumatology Practice, Bayreuth
  13. 13Medicine V, University of Heidelberg, Heidelberg
  14. 14Rheumatology Practice, Nuernberg
  15. 15Schlosspark-Klinik, Teaching Hospital Charite, Internal Medicine, Rheumatology, Berlin
  16. 16University Hospital Tuebingen, Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Department of Internal Medicine II, Tübingen
  17. 17Praxiszentrum St.Bonifatius Muenchen, Muenchen, Germany

Abstract

Background Autoimmunity is still present in rheumatoid arthritis patients in sustained disease remission. In the absence of inflammation the pattern of autoimmunity against post-translationally modified proteins could potentially impact the course of disease of rheumatoid arthritis patients, espepcially their risk to experience relapse of disease when disease modifying anti-rheumatic drugs (DMARDs) are tapered or stopped

Objectives To perform a detailed analysis of the autoantibody response against post-translationally modified proteins in rheumatoid arthritis (RA) patients in sustained remission and to test whether its composition influences the risk for disease relapse when tapering DMARD therapy.

Methods Immune responses against 10 citrullinated, homocitrullinated/carbamylated and acetylated peptides, as well as unmodified vimentin (control) and cyclic citrullinated peptide 2 (CCP2) were tested in baseline serum samples from 94 patients of the RETRO study. Patients were classified according to the number of autoantibody reactivities (0–1/10, 2–5/10 and >5/10) or specificity groups (citrullination, carbamylation and acetylation; 0 to 3) and tested for their risk to develop relapses after DMARD tapering. Demographic and disease-specific parameters were included in multivariate logistic regression analysis for defining the role of autoantibodies in predicting relapse.

Results Patient varied in their anti-modified protein antibody response with the extremes from recognition of no (0/10) to all antigens (10/10). Antibodies against citrullinated vimentin (51%), acetylated ornithine (46%) and acetylated lysine (37%) were the most frequently observed sub-specificities. Relapse risk significantly (p=0.011) increased from 18% (0–1/10 reactivities) to 34% (2–5/10) and 55% (>5/10). With respect to specificity groups (0 to 3), relapse risk significantly (p=0.021) increased from 18% (no reactivity) to 28%, 36% and finally to 52% with one, two or three antibody specificity groups, respectively.

Conclusions The data suggest that the pattern of anti-modified protein antibody response determines the risk of disease relapse in RA patients tapering DMARD therapy.

Disclosure of Interest C. Figueiredo: None declared, H. Bang Employee of: Organtec Diagnostica, J. Cobra: None declared, M. Englbrecht: None declared, A. Hueber: None declared, J. Haschka: None declared, B. Manger: None declared, A. Kleyer: None declared, M. Reiser: None declared, S. Finzel: None declared, H.-P. Tony: None declared, S. Kleinert: None declared, J. Wendler: None declared, F. Schuch: None declared, M. Ronneberger: None declared, M. Feuchtenberger: None declared, M. Fleck: None declared, K. Manger: None declared, W. Ochs: None declared, M. Schmitt-Haendle: None declared, H.-M. Lorenz: None declared, H. Nuesslein: None declared, R. Alten: None declared, J. Henes: None declared, K. Krueger: None declared, J. Rech: None declared, G. Schett: None declared

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