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AB0191 Clinical significance of multiple autoantibody specificities in rheumatoid arthritis: the role of anti-citrullinated alpha enolase and anti-interferon inducible protein 16
  1. A Alunno1,
  2. O Bistoni1,
  3. F Pratesi2,
  4. V Caneparo3,
  5. GMC La Paglia1,
  6. I Puxeddu2,
  7. M De Andrea4,
  8. E Bartoloni1,
  9. S Landolfo4,
  10. P Migliorini2,
  11. R Gerli1
  1. 1Department of Medicine, Rheumatology Unit, University of Perugia, Perugia
  2. 2Department of Clinical and Experimental Medicine, University of Pisa, Pisa
  3. 3Department of Traslational Medicine, University of Piemonte Orientale Amedeo Avogadro, Novara
  4. 4Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy


Background Anti-cyclic citrullinated peptide (anti-CCP) auto-antibodies (auto-Abs) represent the current gold standard for the diagnosis of rheumatoid arthritis (RA). However, growing evidence suggests that a variety of other citrullinated or not citrullinated self-proteins may act as autoantigens and lead to the production of auto-Abs. The identification of the diagnostic and/or prognostic value of such novel auto-Abs is under intense investigation. We recently demonstrated that RA patients display a higher prevalence of auto-Abs against the interferon-inducible protein 16 (anti-IFI16) but these auto-Abs do not have a good diagnostic value (1). Recent data showed that auto-Abs against citrullinated alpha-enolase (anti-CEP1) are associated with erosive RA (2).

Objectives The purpose of this study was to investigate the possible prognostic value of anti-CEP-1 and anti-IFI16 as well as the clinical implication of their association with anti-CCP in a cohort or RA patients.

Methods Two hundred and fifty two RA patients were enrolled and serum samples were obtained. Auto-Abs were assessed as follows: anti-CCP EDIA 2nd generation ELISA kit (Eurodiagnostica); anti-CEP-1 IgG ELISA kit (Euroimmun). In a subgroup of 113 patients also anti-IFI16 auto-Abs were assessed with an in-house ELISA kit (1). Clinical and serological records of patients were collected and statistical analysis was performed with SPSS 21.0 software.

Results One hundred and twenty patients (44%) displayed anti-CEP-1 auto-Abs and of these 97 patients (87%) also displayed anti-CCP. Logistic regression analysis revealed an association between both auto-Abs and RA-associated pulmonary disease (odds ratio-OR=2.9; 95% CI=1.06–7.9; p=0.04). We also confirmed that anti-CEP-1 are associated with erosive RA but of interest to a greater extent compared to anti-CCP (anti-CEP-1: OR=4.12; p=0.04; anti-CCP: OR=2.1; p=0.03). The analysis that included anti-IFI16 auto-Abs revealed that a small proportion of patients display all the three auto-Abs (9%) but the triple positivity was significantly associated with male gender (OR=3.5; p=0.02), the presence of rheumatoid nodules (OR=5,3; p=0.015) and pulmonary involvement (OR=2.6; p=0.007). Anti-IFI16 auto-Abs were associated to male gender independently of the presence of the other two auto-Abs.

Conclusions Our study demonstrated that anti-CEP-1 auto-Abs may participate to the development of RA-associated pulmonary manifestation together with anti-CCP and that the assessment of multiple auto-Abs in daily practice may help clinician to stratify RA patients at identify those at higher risk to develop extra-articular manifestations.


  1. Alunno A et al. Arthritis Care Res (Hoboken) 2016;68(4):440–5.

  2. Montes A et al. Arthritis Rheum 2012;64(10):3102–3110.


Disclosure of Interest None declared

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