The role of anti-cyclic citrullinated peptide antibodies in predicting rheumatoid arthritis

The study presents the results of predicting role of anti-cyclic citrullinated peptide antibodies in rheumatoid arthritis, compared to rheumatoid factor. 32 patients with rheumatoid arthritis were identified from a retrospective chart review. The results of our study show that presence of the rheumatoid factor has less diagnostic and prognostic significance than the anti-cyclic citrullinated peptide, and suggests its superiority in predicting an erosive disease course.     

Prospective cohort study of effects of infliximab on rheumatoid factor,anti-cyclic citrullinated peptide antibodies and antinuclear antibodies in patients with long-standing rheumatoid arthritis

BackgroundAntibodies to cyclic citrullinated peptide (anti-CCP) and IgM rheumatoid factor (IgM-RF) are well-established serological markers for rheumatoid arthritis (RA). Lupus-like disease with antinuclear antibodies (ANA) has been reported during TNFα antagonist therapy. Our objectives were to investigate the effect of infliximab therapy on these three autoantibodies in patients with established RA and to look for correlations linking IgM-RF and anti-CCP titres to a treatment response (defined as a good or moderate EULAR response) after 48 weeks of infliximab therapy.MethodsThirty-six patients with long-standing RA not responding to disease-modifying anti-rheumatic drugs (DMARDs) received intravenous infliximab (starting dose: 3 mg/kg) at 0, 2, and 6 weeks then at 8-week intervals, in combination with a DMARD. At baseline, week 24, and week 48, C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were determined and the disease activity score (DAS28) was calculated. Serum samples collected at the same time points were used to measure anti-CCP (commercial second-generation ELISA), IgM-RF (quantitative nephelometric assay), and ANA (indirect immunofluorescence in HEp2 cells). Correlations linking baseline autoantibody titres to changes in autoantibody levels were examined.ResultsAt baseline, tests were positive for anti-CCP in 31/36 (94.6%) patients, IgM-RF in 29/36 (80.5%) patients, and ANA in 16/36 (44%) patients. IgM-RF titres decreased significantly (p < 0.001), whereas anti-CCP showed little change (p = 0.053). ANA titres increased significantly (p < 0.001). The treatment response was not associated with changes in anti-CCP or IgM-RF titres during infliximab therapy (OR for a response in patients with a 50% anti-CCP decrease, 0.77 [95%CI, 0.16–3.58]; OR for a response in patients with a 50% IgM-RF decrease, 0.82 [95%CI, 0.16–4.13]).ConclusionsDuring infliximab therapy used to treat established RA, IgM-RF titres showed larger decreases than anti-CCP titres. Changes in IgM-RF and anti-CCP failed to correlate with the 48-week treatment response.     

The relationship between the presence of anti-cyclic citrullinated peptide antibodies and clinical phenotype in very early rheumatoid arthritis

Background  

Anti-cyclic citrullinated peptide (anti-CCP) antibodies are highly specific for RA, but are not detectable in all RA patients. The aim of this study was to establish whether the clinical phenotypes of anti-CCP positive and negative disease are distinct at the earliest clinically apparent phase of disease.     

The relationship between peripheral arthritis and anti-cyclic citrullinated peptide antibodies in ankylosing spondylitis

ObjectivesAlthough ankylosing spondylitis (AS) primarily affects the axial skeleton, peripheral arthritis occurs in up to 35% of cases. Anti-cyclic citrullinated peptide (anti-CCP) antibodies are highly specific for rheumatoid arthritis, whereas their role in AS remains unclear. In this study we aimed to assess the prevalence of anti-CCP antibodies in AS patients with peripheral arthritis and their clinical association with peripheral arthritis.MethodsWe retrospectively selected for this study 625 AS patients who fulfilled the modified New York criteria. The patients were divided into those with and those without peripheral arthritis on smoking history, the basis of symptoms, physical examination and medical records. The presence of anti-CCP antibodies was investigated in all the patients.ResultsAnti-CCP antibodies were found in 4% (25/625) of the patients, and peripheral arthritis was diagnosed in 37.4% (234/625) of the patients. In multiple logistic regression, peripheral arthritis was significantly associated with female gender (P = 0.001) and the presence of anti-CCP antibodies (P = 0.001), especially with the presence of titers of anti-CCP antibodies over three times the normal upper limit of the laboratory and assay.ConclusionsAnti-CCP antibodies are occasionally present in AS, and their presence may be helpful as a serum marker for predicting peripheral arthritis.     

Anti -citrullinated peptide antibodies profiling in established rheumatoid arthritis

Objectives

Anti-citrullinated protein/peptide antibodies (ACPA) represent an important tool for the diagnosis of rheumatoid arthritis (RA) and the presence of multiple ACPA specificities is highly correlated with the evolution towards RA. However, little is known about the association of single specificities with disease manifestations and response to therapy in established RA. The aim of this work is to evaluate in a retrospective study the clinico-serological association of ACPA detected using VCP1 and VCP2 (EBV-derived citrullinated peptides) and HCP1 and HCP2 (histone-H4-derived citrulinated peptides) in established RA.

瓜氨酸化蛋白在类风湿关节炎中的研究进展

研究发现,瓜氨酸化蛋白(Citrullinated Protein)是导致类风湿关节炎(rheumatoid arthritis,RA)发病的重要靶抗原之一,其相对应的血清抗环瓜氨酸肽(CCP)抗体被认为是目前RA早期诊断的血清学指标中最有前途的特异性诊断抗体。本文主要对瓜氨酸蛋白在RA中的研究进展做一简要综述。     

Septic arthritis in patients with rheumatoid arthritis

There is an increasing number of rheumatoid patients who get septic arthritis. Chronic use of steroids is one of the important predisposing factors. The clinical picture of septic arthritis is different in immunocompromised patients like patients with rheumatoid arthritis. The diagnosis and management are discussed in this review article.     

Diagnostic and prognostic usefulness of antibodies to citrullinated peptides

The diagnosis of rheumatoid arthritis (RA) must be made early, because prompt initiation of treatments tailored to disease activity is crucial to improve structural and functional outcomes. Anti-citrullinated peptide antibodies (ACPAs) are well-established diagnostic markers for RA and should be included in the classification criteria. Here, we describe the main tests for detecting ACPAs and we underline the diagnostic and prognostic usefulness of ACPAs in patients with RA. The presence of ACPAs predicts poorer functional and structural outcomes, and ACPA titers respond to some of the medications used in RA. Therefore, ACPA titers should be determined at regular intervals throughout follow-up.     

Diagnostic value of radiographs of the hands and feet in early rheumatoid arthritis

The extent to which radiographs of the hands and feet can contribute to the diagnosis of early rheumatoid arthritis (RA) has received little research attention. Yet, the workup for recent-onset inflammatory joint disease usually includes radiographs of the hands and feet. We reviewed the literature for data on the value of these radiographs for diagnosing early RA. We sought to determine whether radiographic changes in the hands and feet constitute a valid diagnostic criterion, i.e., show good discrimination, good reproducibility, and an ability to detect early disease. Furthermore, we evaluated whether the sensitivity, specificity, and positive and negative predictive values of these changes could be calculated from published data. Few cohort studies of early inflammatory joint disease have been published, and the data come mainly from studies in early RA. Among radiographic alterations described to date, erosions seem associated with the best reliability and discriminating power. Radiographic alterations are of limited sensitivity for early rheumatoid arthritis because they occur only after some time. Radiographs of the hands and feet are far easier to obtain than magnetic resonance imaging and ultrasonography, which seem promising but are still undergoing validation.     

Vertical settling in rheumatoid arthritis. Diagnostic value of the Ranawat and Redlund-Johnell methods

The usefulness of the recently developed Ranawat and Redlund-Johnell craniometric methods was compared with that of the conventional McGregor method for diagnosing vertical settling (VS) of the skull and the atlas on the axis in 209 patients with rheumatoid arthritis (RA). Statistical analysis of the values obtained from roentgenograms revealed close correlations among the three methods. The first two methods were superior to the McGregor method because the measuring points could be identified on plain roentgenograms of the cervical spine in virtually all cases. The McGregor value could not be determined in 38 (18%) patients. Since medullary compression could be detected by magnetic resonance imaging in all patients who showed abnormal Redlund-Johnell values, the Redlund-Johnell method may be useful for diagnosing advanced VS. It also detects not only atlantoaxial lesions but also atlantooccipital lesions. Thus, the Redlund-Johnell method appears to be the best method for diagnosing VS in RA patients.     

Diagnostic injections of the hindfoot joints in patients with rheumatoid arthritis prior to surgical fusion

Although surgical fusion of the hindfoot can result in considerable reduction of symptoms in patients with rheumatoid arthritis, results can be unpredictable. Difficulty in identifying the symptomatic joint/joints despite the use of computerized tomography (CT) is one of the factors in this unpredictability. Using fluoroscopic control we have injected preoperatively 2–4 ml of 1% lignocaine and contrast media into either the ankle joint, the subtalar joint complex or both joints in 35 patients and prospectively assessed them clinically and with radiographs and CT.The ankle joint was injected initially and if symptom resolution was achieved the subtalar joint was not injected. The patients scored pain levels on an analogue scale from 0 to 10. A total of 82 joints were injected in 41 feet. The average pain score was 8.6 (5–10) before and 3.2 (0–9) after injection.The effect was often dramatic and in 13 feet (31%) was prolonged, lasting up to several months. In 16 (39%) the initial decision regarding arthrodesis based on clinical assessment and radiology was altered following the injection response.Diagnostic injection has an important role to play in association with clinical examination, plain radiographs and CT in the preoperative assessment of these patients.     

Intubation difficulties in patients with rheumatoid arthritis

Background : Fibreoptic intubation has been suggested to be the best method to manage a compromised airway. This retrospective study was designed to compare endotracheal intubation with the help of a rigid laryngoscope or a fibrescope in patients with rheumatoid arthritis.
Methods : Intubation difficulties with the laryngoscope and the fibrescope in patients with rheumatoid arthritis were investigated during a period of five and a half years. The anaesthesia records were used for analysis. The patients were divided into two groups (group I with 41 patients and group II with 37 patients) reflecting the change in the routine airway management in patients with rheumatoid arthritis in our hospital from the beginning of 1993. Before that time the patients were usually intubated orotracheally under general anaesthesia, but since 1993 rheumatoid patients with anticipated difficulties in endotracheal intubation have been preferably intubated fibreoptically awake under sedation and topical anaesthesia with a fibrescope.
Results : Major difficulties in endotracheal intubations were encountered in 13% of patients in group I and in 8% in group II. On two occasions in group I tracheostomy was needed. In one of these patients, emergency tracheostomy was performed. In the latter group, the main reason for prolonged fibreoptic intubations was lack of experience.
Conclusion : The introduction of fibreoptic intubation technique has had a favourable influence on the safety in the airway management of surgical patients with rheumatoid arthritis.