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In juvenile idiopathic arthritis (JIA) patients there is a lack of markers that predict severe disease. Although anticitrullinated protein antibodies (ACPA) have contributed substantially to the understanding of rheumatoid arthritis (RA),1 their detection in JIA has not been equally useful as incidence rates in JIA patients are low2 and merely confined to the polyarticular immunoglobulin (Ig)M-rheumatoid factor (RF)-positive category resembling RA. Recently, anticarbamylated protein (anti-CarP) antibodies were detected in 45% of RA patients and importantly also in 16%–20% ACPA-negative patients.3–5 Within the ACPA-negative patients, anti-CarP antibodies were associated with more severe radiographic progression.3 Since most JIA patients are ACPA-negative we investigated whether anti-CarP antibodies are present in the sera of JIA patients and how they are related to ACPA and IgM-RF.
JIA patients from three Dutch sources were included: the BeSt for Kids trial (NTR 1574, a treatment strategy study) (n=33), a previously described cohort6 (n=48) and the Arthritis and Biologicals in Children (ABC) register7 (n=153). Healthy controls (n=107) (mean age/range 11/(2–20)) are stem-cell …
Contributors PCEHM, JA, JS, THCMR, MHO, MJDvT, CMJvdZ, EPH, YK-K, SSMK, KD, JMvdB, MAJvR, LWAvS-S, MWS and RtC all contributed data. DMCB, CFA, LWAvS-S, PCEHM, JA, JS, TWJH, RtC, REMT and LAT contributed to the design of the study. PCEHM, JA, JS and EWNL performed tests. PCEHM, JA and JS performed analyses. PCEHM, JA, JS and LAT wrote the manuscript. All authors critically reviewed the draft manuscript and approved the version to be published.
Funding This study was also supported by the Netherlands Genomics Initiative (NGI) as part of the Netherlands Proteomics Center (NPC) and the Center for Medical Systems Biology (CMSB). LAT was financially supported by a VIDI grant from NWO-Zon-MW and a fellowship from Janssen Biologics. REMT was financially supported by a VICI grant from NWO-Zon-MW. PCEHM and The BeSt for Kids study are financially supported by Pfizer. RtC received research grants by the Dutch Arthritis Association. The ABC register is receiving unconditional support of The Board of Health Insurances (2003-2006), Pfizer (since 2007) and Abbott (since 2010). The authors wish to acknowledge the support of the European Union (FP6 integrated project Autocure, FP7 integrated project Masterswitch and IMI JU funded project BeTheCure, contract no 115142-2).
Competing interests None.
Ethics approval Institutional Review Board of Leiden University Medical Center.
Provenance and peer review Not commissioned; externally peer reviewed.
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