Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Anticitrullinated Peptide Antibodies (ACPAS) in the Sera of Heavy Smokers without Arthritis. A Differential Role of Associated Pulmonary Disease?

Ruiz-Esquide3,  Virginia, Gomara4,  María José, Peinado1,  Víctor, Puerta3,  José Alfredo Gómez, Hernandez2,  María Victoria, Barbera1,  Joan A., Ramirez3,  Julio

Pneumology Service, Hospital Clínic of Barcelona, Barcelona, Spain
Rheumatology Service, Hospital Clínic of Barcelona, Barcelona, Spain
Rheumatology Service. Hospital Clínic of Barcelona, Barcelona, Spain
Unit of Synthesis and Biomedical Applications of Peptides, IQAC-CSIC, Barcelona, Spain


Anti-citrullinated peptide antibodies (ACPAs) are the most specific serological markers of rheumatoid arthritis (RA). An increased risk of RA has been described in smokers, but only in ACPA-positive RA patients. The frequency of ACPAs in serum of heavy smokers is not known.


To analyze the frequency and levels of ACPAs in the serum of heavy smokers subjects, with and without lung disease, and to compare them with a healthy control group.


Serum samples of 110 heavy smokers (39% women, mean age 56.9 ± 10 years) were obtained. Subjects were selected, from a Pneumology Service data base and from hospital health workers, regardless of wheather they had chronic obstructive lung disease (COPD) or not. Study subjects were compared with a healthy control group who had never smoked (51% women, 41.8 ± 12 years) (n=209). Both groups were tested for two different antibodies against citrullinated proteins, a commercial CCP2 test and a home-made chimeric fibrin/filaggrin citrullinated synthetic peptide (anti-CFFCP). The frequency of positive results and autoantibody levels were compared between groups.


Of the 110 heavy smokers, 54 had COPD and 56 were healthy smokers. None had RA. Mean pack-years were 44.3 ± 36 (53 ± 28 in COPD disease and 36 ± 16 in healthy smokers, p<0.01).

The percentage of positive results together with the mean serum levels of the two citrullinated autoantibodies in all the study groups are shown in Table 1.

The prevalence of positive anti-CFFCP was higher in the heavy smoker group than in non smokers, although the difference was not significant. The highest prevalence of positive anti-CFFCP was seen in patients with COPD (7.4%); the difference was at the limit of statistical significance compared with the control group (2.4%) (OR 3.26 95% CI 0.85–12.6 p=0.07). There was no significant difference in the frequency of positive anti-CCP antibodies between groups.

The differences in the mean serum levels of anti-CFFCP and anti-CCP antibodies in heavy smokers compared with never smokers were not statistically significant. Heavy smokers with COPD had significantly higher levels of both autoantibodies than those without pulmonary disease, although almost all patients had serum levels bellow the cut-off values.

Table 1. Frequency (%) of patients with positive autoantibodies and mean serum levels of antibodies in the study groups.

 A TOTAL n = 110B COPD n = 54C NON COPD n = 56D n = 209
CFFCP+ (%)5 (4.5%)4 (7.4%)*1 (1.7%)5 (2.4%)*
CFFCP mean ± SD0.12 ± 0.060.15 ± 0.7†0.09 ± 0.5†0.10 ± 0.12
CCP2+ (%)2 (1.8%)2 (3.7%)0 (0%)4 (1.9%)
CCP2 mean ± SD15.62 ± 4.2516.2 ± 5.97‡15.05 ± 0.9‡16.9 ± 2.78
*B vs D: p = 0.07
†B vs C: p = 0.013
‡B vs C: p = 0.003


ACPAs are rarely seen in the sera of non-arthritic heavy smokers. However the production of these autoantibodies seems to be higher in heavy smokers patients with associated COPD disease. Larger series studies are necessary to confirm these findings and to ascertain the relationship between ACPAs and inflammatory lung disease.

To cite this abstract, please use the following information:
Ruiz-Esquide, Virginia, Gomara, María José, Peinado, Víctor, Puerta, José Alfredo Gómez, Hernandez, María Victoria, Barbera, Joan A., et al; Anticitrullinated Peptide Antibodies (ACPAS) in the Sera of Heavy Smokers without Arthritis. A Differential Role of Associated Pulmonary Disease? [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1070
DOI: 10.1002/art.28837

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