RT Journal Article
SR Electronic
T1 The extent of the anti-citrullinated protein antibody repertoire is associated with arthritis development in patients with seropositive arthralgia
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 128
OP 133
DO 10.1136/ard.2010.132662
VO 70
IS 1
A1 van de Stadt, Lotte A
A1 van der Horst, Ann R
A1 de Koning, Margret H M T
A1 Bos, Wouter H
A1 Wolbink, Gerrit Jan
A1 van de Stadt, Rob J
A1 Pruijn, Ger J M
A1 Dijkmans, Ben A C
A1 van Schaardenburg, Dirkjan
A1 Hamann, Dörte
YR 2011
UL http://ard.bmj.com/content/70/1/128.abstract
AB Objectives To determine the fine specificity of anti-citrullinated protein antibodies (ACPA) in the early phase of arthritis development, the ACPA repertoire in arthralgia patients and the association with arthritis development were studied. Methods A total of 244 patients with arthralgia positive for anti-cyclic citrullinated peptide antibodies (aCCPs) and/or IgM rheumatoid factor (IgM-RF), without arthritis were included. Development of arthritis was defined as presence of one or more swollen joints at clinical examination during follow-up. Sera were tested at baseline for reactivity to five citrullinated peptides derived from fibrinogen (three), vimentin (one) and α-enolase (one) and five corresponding arginine peptides in an ELISA. Results In all, 69 patients (28%) developed arthritis in a median of 3 joints after a median follow-up of 11 (IQR 5–20) months. Reactivity to each peptide was significantly associated with arthritis development (p<0.001). The ACPA repertoire did not differ between patients who did or did not develop arthritis. Among aCCP-positive patients, patients recognising two or more additional citrullinated peptides developed arthritis more often (p=0.04). The number of recognised peptides was positively associated with the aCCP level (p<0.001). Crossreactivity between different peptides was minimal. Conclusions Arthritis development is not associated with recognition of a specific citrullinated peptide once joint complaints are present. The ACPA repertoire in some patients with arthralgia is expanded. High aCCP levels are associated with a qualitatively broad ACPA repertoire. Patients with an extended ACPA repertoire have a higher risk of developing arthritis.