The Relationship between Anti-Cyclic Citrullinated Peptide Positivity and Clinical/Radiological Findings in Patients with Psoriatic Arthritis

Year 2022, , 687 - 693, 28.12.2022

Özlem Özdemir Işık , Fulya Coşan , Ayten Yazıcı , Ayşe Çefle

https://doi.org/10.31832/smj.996517

Abstract

Psoriatic arthritis (PsA) is a chronic inflammatory disease in the spondyloarthropathy group with the history of psoriasis. Although some PsA findings are similar to rheumatoid arthritis (RA), rheumatoid factor negativity, some radiological and clinical findings are different in PsA. There is no spesific laboratory examination for diagnosis of PsA. On the other hand, anti-cyclic citrullinated peptide (anti-CCP) antibody positivity is a spesific finding for the diagnosis of RA.
Objectives: We aimed in this study to analyse the frequency of anti-CCP positivity in PsA and the association with clinical and radiological findings.
Methods: The study group is consisted of 100 PsA patients, who fulfilled the CASPAR cirteria for PsA and 100 healthy controls (HC). We filled a form for all patients, which included clinical and laboratory findings of patients. We analyzed anti-CCP antibody with micro-ELISA in the sera of patients.
Results: In our study, the anti-CCP positivity was detected in 15% of PsA group and 4% of healthy controls. The difference was statistically significant (p=0,014; OR=4.24, 95% CI=1.35–13.25). Nine out of 15 anti-CCP positive patients were female, the remaining 6 were male. Thirteen patients (86,7%) had peripheral arthritis, 1 patient (6,7%) had sacroiliitis, 1 patient (6,7%) had peripheral arthritis and sacroiliitis. 42,8% of PsA patients with peripheral arthritis had asymetric olygoarthritis (6/14), 28,5% had monoarthritis (4/14) and 28,5% had symetric polyarthritis (4/14). Anti-CCP antibody positivity had no effect on the involvement of peripheral arthritis. Sacroiliitis and dactilitis were more frequent in the anti-CCP negative group. No patient with dactylitis had anti-CCP positivity (p=0.005). While, 43,5% of RF positive patients were detected anti-CCP positivity, 6,5% of RF negative patients were detected anti-CCP positivity (p=0,000).
Conclusions: Our data reveals that anti-CCP positivity is more frequent in PsA compared to HC. We found no statisticall association between anti-CCP positivity and clinical or radiological findings.

Keywords

Psoriatic Arthritis; Anti-Cyclic Citrullinated Peptide; Rheumatoid Factor

Supporting Institution

-

Project Number

-

Thanks

-

Psöriyatik Artritli Hastalarda Anti-Siklik Sitrülinli Peptit Pozitifliği ile Klinik/Radyolojik Bulgular Arasındaki İlişki

Abstract

Psöriatik artrit (PsA), psöriazis öyküsü olan spondiloartropati grubundaki kronik inflamatuar bir hastalıktır.
Bazı PsA bulguları romatoid artrit (RA) ile benzer olmasına rağmen, romatoid faktör negatifliği ile bazı radyolojik ve klinik bulgular PsA'da farklıdır. PsA tanısı için özel bir laboratuvar testi yoktur. Öte yandan anti-siklik sitrüline peptit (anti-CCP) antikor pozitifliği RA tanısı için spesifiktir.


Amaç: Bu çalışmada PsA'da anti-CCP pozitifliğinin sıklığını, klinik ve radyolojik bulgularla ilişkisini incelemeyi amaçladık.


Yöntemler: Çalışma grubu, PsA için CASPAR kriterlerini karşılayan 100 PsA hastası ve 100 sağlıklı kontrolden (SK) oluşmaktadır. Tüm hastalar için, klinik ve laboratuvar bulgularını içeren bir form doldurulduk ve hastaların serumlarında anti-CCP antikorunu mikro-ELISA yöntemi ile analiz ettik.
Bulgular: Çalışmamızda PsA grubunun %15'inde ve sağlıklı kontrollerin %4'ünde anti-CCP pozitifliği saptandı. Fark istatistiksel olarak anlamlıydı (p=0.014; OR=4.24, %95 GA=1.35-13.25). 15 anti-CCP pozitif hastanın dokuzu kadın, geri kalan 6'sı erkekti. On üç hastada (%86,7) periferik artrit, 1 hastada (%6,7) sakroiliit, 1 hastada (%6,7) periferik artrit ve sakroiliit vardı. Periferik artritli PsA hastalarının %42,8'inde asimetrik oligoartrit (6/14), %28,5'inde monoartrit (4/14) ve %28,5'inde simetrik poliartrit (4/14) vardı. Anti-CCP antikor pozitifliğinin periferik artrit tutulumu üzerine etkisi yoktu. Anti-CCP negatif grupta sakroiliit ve daktilit daha sıktı. Daktilitli hiçbir hastada anti-CCP pozitifliği yoktu (p=0,005). RF pozitif hastaların %43,5'inde anti-CCP pozitifliği saptanırken, RF negatif hastaların %6,5'inde anti-CCP pozitifliği saptandı (p=0,000).
Sonuç: Verilerimiz, SK'e kıyasla PsA'da anti-CCP pozitifliğinin daha sık olduğunu ortaya koymaktadır. Ancak Anti-CCP pozitifliği ile klinik veya radyolojik bulgular arasında istatistiksel bir ilişki bulunmamıştır.

Keywords

PSÖRİYATİK ARTRİT, ANTİ-SİKLİK SİTRÜLİNLİ PEPTİT, ROMATOİD FAKTÖR

Project Number

-

References

• 1. Ritchlin CT, Kavanaugh A, Gladman DD, Mease PJ, Helliwell P, Boehncke W-H, et al. Treatment recommendations for psoriatic arthritis. Ann Rheum Dis. 2009; 68:1387-94.
• 2. Ritchlin CT, Haas-Smith SA, Li P, Hicks DG, Schwarz EM . Mechanisms of TNF- alpha and RANKL-mediated osteoclastogenesis and bone resorption in psoriatic arthritis. J Clin Invest 2003;111(6):821-31.
• 3. Helliwell PS, Taylor WJ. Classification and diagnostic criteria for psoriatic arthritis. Ann Rheum Dis 2005;64(Suppl II): ii3-8.
• 4. Nienhuis RLF, Mandema E. A new serum factor in patients with rheumatoid arthritis, the antiperinuclear factor. Ann Rheum Dis 1964; 23:302-5.
• 5. Sebbag M, Simon M, Vincent C, Masson-Bessière C, Girbal E, Durieux JJ et al. The antiperinuclear factor and the so-called anti-keratin antibodies are the same rheumatoid arthritis-specific antibodies. J Clin Invest 1995; 95:2672-9.
• 6. Schellekens GA, Visser H, de Jong BA, van den Hoogen F H, Hazes JM, Breedveld FC et al. The diagnostic properties of rheumatoid arthritis antibodies recognising a cyclic citrullinated peptide. Arthritis Rheum 2000; 43:155-63.
• 7. Gottenberg JE, Mignot S, Nicaise-Rolland P, Cohen-Solal J, Aucouturier F, Goetz J et al. Prevalence of anticyclic citrullinated peptide and anti-keratin antibodies in patients with primary Sjogren’s syndrome. Ann Rheum Dis 2005; 64:114-7.
• 8. Mediwake R, Isenberg DA, Schellekens GA, van Venrooij W J. Use of anti-citrullinated peptide and anti-RA33 antibodies in distinguishing erosive arthritis in patients with systemic lupus erythematosus and rheumatoid arthritis. Ann Rheum Dis 2001; 60:67-8.
• 9. Avcin T, Cimaz R, Falcini F, Zulian F, Martini G, Simonini G et al. Prevalence and clinical significance of anti-cyclic citrullinated peptide antibodies in juvenile idiopathic arthritis. Ann Rheum Dis 2002; 61:608-11.
• 10. Hromadnikova I, Stechova K, Pavla V, Hridelova D,Houbova B, Voslarova S et al. Anti-cyclic citrullinated peptide antibodies in patients with juvenile idiopathic arthritis. Autoimmunity 2002; 35:397-401. 11. Jansen AL, van der Horst-Bruinsma I, van Schaardenburg D, van de Stadt RJ, de Koning MH, Dijkmans BA. Rheumatoid factor and antibodies to cyclic citrullinated peptide differentiate rheumatoid arthritis from undifferentiated polyarthritis in patients with early arthritis. J Rheumatol 2002; 29:2074-6.
• 12. Kroot E-JA, de Jong BA, Van Leeuwen MA, Swinkels H, van den Hoogen FH, van't Hof M et al. The prognostic value of anti-citrullinated peptide antibody in patients with recent onset rheumatoid arthritis. Arthritis Rheum 2000; 43:1831-5.
• 13. Goldbach-Mansky R, Lee J, McCoy A, Yarboro C, Smolen J S, Steiner G et al. Rheumatoid arthritis associated autoantibodies in patients with synovitis of recent onset. Arthritis Res 2000; 2:236-43.
• 14. Rantapaa Dahlqvist S. Diagnostic and prognostic significance of autoantibodies in early rheumatoid arthritis. Scand J Rheumatol 2005; 34:83–96.
• 15. Van Gaalen FA, Linn-Rasker SP, van Venrooij WJ, de Jong BA, Breedveld F C, Verweij C L et al. Autoantibodies to cyclic citrullinated peptides predict progression to rheumatoid arthritis in patients with undifferentiated arthritis: a prospective cohort study. Arthritis Rheum 2004; 50:709-15.
• 16. Lee DM, Schur PH. Clinical utility of the anti-CCP assay in patients with rheumatic diseases. Ann Rheum Dis 2003; 62:870-4.
• 17. Vander Cruyssen B, Hoffman IE, Zmierczak H, Van den Berghe M, Kruithof E, De Rycke L et al. Anti-citrullinated peptide antibodies may occur in patients with psoriatic arthritis. Ann Rheum Dis 2005; 64:1145-9.
• 18. Alenius GM, Berglin E, Rantapää Dahlqvist S. Antibodies against cyclic citrullinated peptide (CCP) in psoriatic patients with or without oint inflammation. Ann Rheum Dis 2006; 65:398-400.
• 19. Candia L, Marquez J, Gonzalez C, Santos AM, Londoño J, Valle R et al. Low frequency of anticyclic citrullinated peptide antibodies in psoriatic arthritis but not in cutaneous psoriasis. J Clin Rheumatol 2006; 12:226-9.
• 20. Bogliolo L, Alpini C, Caporali R, Scirè CA, Moratti R, Montecucco C. Antibodies to cyclic citrullinated peptides in psoriatic arthritis. J Rheumatol 2005; 32:511-15.
• 21. Korendowych E, Owen P, Ravindran J, Carmichael C, McHugh N. The clinical and genetic associations of anti-cyclic citrullinated peptide antibodies in psoriatic arthritis. Rheumatology (Oxford) 2005; 44:1056-60.
• 22. Inanc N, Dalkilic E, Kamali S, Kasapoglu-Günal E, Elbir Y, Direskeneli H et al. Anti-CCP antibodies in rheumatoid arthritis and psoriatic arthritis. Clin Rheumatol 2007; 26:17-23.
• 23. Abdel Fattah NSA, Hassan HE, Galal ZA, El Okda ESE. Assessment of anti-cyclic citrullinated peptide in psoriatic arthritis. BMC Research Notes 2009; 2: 44.
• 24. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H; CASPAR Study Group. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006 Aug;54(8):2665-73.
• 25. Clegg DO, Reda DJ, Mejias E, Cannon GW, Weisman MH, Taylor T et al. Comparison of sulfasalazine and placebo in the treatment of psoriatic arthritis. Arthritis Rheum 1996; 39:2013-20.
• 28. McGonagle D, Conaghan P, Emery P. Psoriatic arthritis: a unified concept twenty years on. Arthritis Rheum 1999; 42:1080-6.
• 27. Moll JM, Wright V. Psoriatic arthritis. Semin Arthritis Rheum. 1973; 3:55-78.
• 28. Gladman DD, Shuckett R, Russell ML, Thorne JC, Schachter RK. Psoriatic arthritis (PsA) an analysis of 220 patients. Q J Med 1987; 62:127-41.
• 29. Nossent JC, Gran JT. Epidemiological and clinical characteristics of psoriatic arthritis in northern Norway. Scand J Rheumatol 2009; 38:251-255.
• 30. Kane D, Stafford L, Bresnihan B, FitzGerald O. A prospective, clinical and radiological study of early psoriatic arthritis: an early synovits clinic experience. Rheumatology (Oxford) 2003; 42:1460-8.
• 31. Cantini F, Niccoli L, Nannini C, Kaloudi O, Bertoni M, Cassarà E. Psoriatic arthritis: a systematic review. International Journal of Rheumatic Diseases 2010; 13:300-17.
• 32. Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM. Time trends in epidemiology and characteristics of psoriatic arthritis over 3 decades: a population-based study. J Rheumatol 2009; 36:361-7.