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.


Anti-Cyclic Citrullinated Peptide Antibodies: Beyond Rheumatoid Arthritis.

Grados,  Dolors, Martinez-Morillo,  Melania, Holgado,  Susana, Minguez,  Sonia, Molto,  Anna, Tejera,  Beatriz, Mateo,  Lourdes

Background:

The determination of anti-cyclic citrullinated peptide antibodies has diagnostic and prognostic value in rheumatoid arthritis, with a sensitivity similar to that of the rheumatoid factor and of greater specificity.

Objectives:

To describe the clinical characteristics of a cohort of patients with positive anti-cyclic citrullinated peptide antibodies.

Methods:

The retrospective study was done at the university hospital with a reference population of 700,000 between 2007 and 2009. We reviewed the medical records of patients with anti-cyclic citrullinated peptide antibodies (citrullinated vimentin peptides) greater than or equal to 20 U/ml excluding those cases without clinical information. Technique used: ELISA anti-CMV (Orgentec, Freiburg, Germany).

Results:

We carried out 1222 determinations, of which 418 (34%) were positive. We analyzed 320 patients: 103 men (32%) and 217 women (68%). In 234 cases (73%) patients had an associated rheumatic disease.

Table 1.

 20–50 U/ml51–100 U/ml101–500 U/ml>500 U/mlTotal
Rheumatoid arthritis21193651127
Elderly-onset arthritis535215
Non-titrated arthritis1842125
Connective and vasculitis3022236
Stills disease12104
Palindromic rheumatism13127
Miscellaneous1531120

64.5% of patients with rheumatoid arthritis, who had values above 100 U/ml, where seropositive and erosive forms. In the cases of vasculitis and connective tissue disease the values were between 20 and 50 U/ml. They were above 50 U/ml only in six patients: 3 with SLE and 3 with Sjogren syndrome. The distribution in Still's disease, palindromic rheumatism and elderly-onset arthritis was similar for all values. 72% of the non-filiated arthritis had values between 20 and 50 U/ml. In the miscellaneous group (psoriatic arthritis, microcrystalline arthritis, polymyalgia rheumatica, sarcoidosis, arthritis associated with inflammatory bowel disease and postinfectious arthritis), 75% had values less than 50 U/ml. The value of 100 U/ml was only exceeded in a case of polymyalgia rheumatica and a case of chondrocalcinosis.

In 86 cases (27%) the patients did not have any associated rheumatic disease.

Table 2.

 20–50 U/ml51–100 U/ml101–500 U/ml>500 U/mlTotal
Endocrinology and nephropathy1622020
Lung disease902011
Hematology and infections1842024
Miscellaneous2830031

Fifteen patients (17%), two of whom were smokers, had values above 50 U/ml. In six cases the values were greater than 100: 2 with nephropathy, 2 with lung disease (pulmonary hypertension and idiopathic pulmonary fibrosis), 1 with autoimmune hemolytic anemia and 1 case of drepanocytosis.

Conclusion:

Although anti-cyclic citrullinated peptide antibodies are highly specific for rheumatoid arthritis, they have also been described in other rheumatic diseases. Values above 100 U/ml usually relate to rheumatoid arthritis. Values between 20–50 U/ml without articular simptoms, must be considered negative, so this determination must be valued only in the context of rheumatic disease.

To cite this abstract, please use the following information:
Grados, Dolors, Martinez-Morillo, Melania, Holgado, Susana, Minguez, Sonia, Molto, Anna, Tejera, Beatriz, et al; Anti-Cyclic Citrullinated Peptide Antibodies: Beyond Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1741
DOI: 10.1002/art.29506

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