RESUMO
Presence of the anti-cyclic citrullinated peptide (CCP) antibody is considered a hallmark of rheumatoid arthritis, and may be found in patients with other rheumatic diseases, including psoriatic arthritis (PsA). The aim of the present study was to determine whether the anti-CCP antibody was present in patients with psoriasis with and without arthritis. and to determine whether its presence was associated with clinical, serological and treatment data in patients with PsA. The present study was a cross-sectional study, which included 91 patients with psoriasis (41 with arthritis and 48 without arthritis) as well as an age and sex matched control group consisting of 100 healthy individuals. Presence of the anti-CCP antibody was determined using commercially available ELISA kits. Data on clinical, serological and treatment characteristics was obtained from reviewing each patient's medical history. The quality of life and articular inflammatory activity were assessed using the Short Form Health Survey-12 questionnaire. Skin disease was evaluated using the Psoriasis Area Severity Index and body surface area. In the control group, 1% of individuals were positive for the anti-CCP antibody, whereas 17.5% of the psoriasis patients were positive (P<0.001). In the patients with PsA, 20.9% were positive for the antibody, and in patients with psoriasis without joint disease, 14.5% were positive (P=0.58). Patients with polyarticular forms of PsA were more likely to be anti-CCP positive compared with patients with skin disease without arthritis (P=0.009). In the group of patients with PsA, those who were anti-CCP positive were more likely to suffer from polyarticular forms of arthritis, but no differences were found in the quality of life, joint disease activity, degree of skin involvement and treatment requirements (all P>0.05). In conclusion, 17.5% of patients with psoriasis and 20.9% of patients with PsA were positive for anti-CCP antibodies. Polyarticular arthritis was more common in the anti-CCP positive patients compared with the anti-CCP negative patients.
RESUMO
Smoking produces substances that activate proinflammatory, prothrombotic and vasoconstrictive mediators via posttranslational carbamylation of proteins. As a new consequence of carbamylation, induction of anti-carbamylated autoantibodies were observed in rheumatoid arthritis (RA) patients, sometimes prior to onset of the disease. The overall aim of this study was to characterize the reactivity of different isotypes of autoantibodies against carbamylated antigens of vimentin in relation to established rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA) and markers of disease activity in a so far largely uncharacterized population of Latin American (Cuban) patients with RA. Antigenic properties of carbamylated vimentin as well as vimentin peptides were analyzed in 101 patients with RA, 50 disease controls and 51 healthy controls. The diagnostic performance was compared with established commercial ELISA rheumatoid factor, anti-cyclic citrullinated peptide antibodies of second generation (anti-CCP2) and anti-mutated citrullinated vimentin (anti-MCV) antibodies. Prevalence of anti-MCV IgG (86 %), anti-carbamylated vimentin (carbVIM) IgG (77 %) and anti-carbamylated MCV (carbMCV) IgG antibodies (65 %) was higher than the classical RF IgM (60 %) and anti-CCP2 IgG (52 %) in this RA cohort. Of note, smoking status was associated with positive IgG antibody reactivity against CCP2 in 75.0 % and against MCV in 90 % of patients. Furthermore, IgM antibody response against carbMCV and carbVIM was observed in 80 and 90.0 % of smokers, respectively. Due to a high sensitivity of the IgM antibody isotype of anti-carbVIM of 85.2 %, the combination of ACPA with anti-carbVIM IgM provided the best diagnostic performance so far achieved in a RA cohort of this ethnic origin. We demonstrate a high prevalence of anti-carbVIM antibodies and correlation with smoking in Latin American (Cuban) RA patients. Anti-carbVIM IgM represents an useful marker in ACPA-negative patients and, in combination with ACPA IgG assays, optimizes the strategy for autoantibody testing.
Assuntos
Artrite Reumatoide/diagnóstico , Autoanticorpos/sangue , Autoantígenos/imunologia , Imunoglobulina M/sangue , Vimentina/imunologia , Adulto , Artrite Reumatoide/sangue , Artrite Reumatoide/etnologia , Artrite Reumatoide/imunologia , Biomarcadores/sangue , Estudos de Casos e Controles , Cuba/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Estudos Soroepidemiológicos , Testes Sorológicos , Fumar/efeitos adversos , Fumar/sangue , Fumar/imunologiaRESUMO
Dentro de las enfermedades autoinmunes, la Artritis Reumatoide es una de las más estudiadas, dada su alta prevalencia. Numerosos estudios han reportado como posible mecanismo gatillante la existencia de una respuesta inmune contra el Colágeno tipo II. El presente trabajo busca contribuir al conocimiento y significación de este proceso, a través de la determinación de diferentes auto-anticuerpos en sujetos con Artritis Reumatoide (diagnosticados bajo criterios del American College of Rheumatology) y en sujetos con artralgias inespecíficas en comparación con sujetos normales. Para esto, se realizó un estudio descriptivo, de corte transversal, en el que se determinó la presencia, en sueros, de anticuerpos anti-colágeno tipo II y de anticuerpos anti-Péptidos Cíclicos Citrulinizados (CCP) por ELISA y de Anticuerpos anti-sinovial por Inmunofluorescencia Indirecta (IFI) con métodos previamente estandarizados de acuerdo a procedimientos convencionales. No se encontró diferencia significativa entre los promedios de los niveles de los anticuerpos anti-colágeno tipo II en los 3 grupos; sin embargo, la distribución de los títulos de anticuerpos presenta, en los tres grupos, curvas de frecuencia de tipo bi-modal cuyos perfiles son totalmente diferentes entre ellos. En este orden, se identificó un subgrupo conformado por el 20 por ciento del grupo con Artritis Reumatoide quienes presentaban anticuerpos anti-colágeno tipo II con niveles muy altos, por encima de las dos desviaciones estándar; dichos sujetos correspondían a adultos jóvenes (edad promedio 41 años) que no recibieron tratamiento inmunosupresor. No se encontró ninguna correlación entre los niveles de anticuerpos anti-colágeno tipo II, los anticuerpos anti-CCP, y los de anticuerpos anti-sinovial. Se discute la significación de estos hallazgos.
Between the Autoimmune Diseases, Rheumatoid Arthritis (RA) is one of the most studied, due to its high prevalence. Several studies have reported as possible shooting mechanism the existence of an immune response against Collagen type II. The present work look for contributing to the knowledge and meaning of the autoimmune process through determinations of different serum antibodies in subjects with Rheumatoid Arthritis (diagnosed under the American College of Rheumatology criteria) and in subjects with unspecific arthralgia in comparison with normal subjects. For this purpose, a transversal descriptive study was carried out, determining the presence of anti-collagen type II antibodies, anti-CCP (Citrulinated Cyclic Peptides) antibodies and anti-synovial antibodies by indirect immuno fluorescence (IFI) in sera, using previously standardized methods according to conventional procedures. No significant differences was found between the averages of the levels of anti-collagen type II in the 3 groups; however, the distribution of the antibody titles shows, in the three groups, curves of frequency of a bi-modal type, with profiles totally different between them. In this order, inside the group with Rheumatoid Arthritis it was identified a subgroup formed by the 20 percent of the subjects that presents very high levels of anti-collagen type II Antibodies (over the two standard deviations), made by young adults (average age 41 years) that did not receive inmunosuppresive treatment. It was not found relationship between the levels of anti-collagen type II antibodies, anti-CCP antibodies and anti-synovial antibodies. The significance of these findings is discussed.