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Role in the diagnosis and prognosis of rheumatoid arthritis RA

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Ann Rheum Dis. 2003;62:870-874. Anti-CCP remain stable over time ... Vander Cruyssen B; Ann Rheum Dis. 2005. Anti-CCP in RA and non-RA rheumatic diseases ... – PowerPoint PPT presentation

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Title: Role in the diagnosis and prognosis of rheumatoid arthritis RA


1
Anti-cyclic citrullinated peptide (CCP) antibodies
Dr. N. Pipitone Dipartimento Area Medica I Unità
Operativa di Reumatologia Direttore Dr. C.
Salvarani
  • Role in the diagnosis and prognosis of rheumatoid
    arthritis (RA)

2
Points
  • Definition
  • Role in diagnosing RA
  • Prognostic role in RA

3
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4
Clin Exp Immunol 2004135173
5
Anti-CCP
  • citrullinated
  • cyclic
  • peptide

6
Points
  • Definition
  • Role in diagnosing RA
  • Prognostic role in RA

7
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8
Newer anti-CCP (anti-CCP2)
  • Meta-analysis of anti-CCP2 in 1117 RA patients
    and 1845 diseased controls (Clin Appl Immunol Rev
    20044239 )
  • Sensitivity 77, specificity 96.1

Rheumatoid factor
  • Sensitivity 72
  • Specificity 80

Ann Rheum Dis 200362870-874
9
Anti-CCP remain stable over time
  • After 3 years, only 5/97 RA patients (ACR
    criteria) changed anti-CCP status (2 from ve to
    ve)
  • In the elderly, lt0.3 are ve for anti-CCP

10
anti-CCP in RF-associated diseases
  • 50 patients with HCV infection without
    cryoglobulinemia
  • 29 patients with mixed cryoglobulinemia (5 of
    whom with arthritis)
  • 20 normal blood donors
  • ELISA Inova Diagnostic, serum dilution of 1100
    CV of 10-15, upper limit 20 U/ml

Arthritis Rheum 2004 50(7)2305
11
Arthritis Rheum 2004 50(7)2305
12
Anti-CCP in primary Sjøgrens syndrome
  • 134 patients with a primary Sjögrens syndrome
    (EU/US consensus criteria)
  • None fulfilled the ACR criteria for RA
  • Long disease duration (ca. 10 years)
  • Eurodiagnostica kit (ve gt50 U/ml)
  • 7.5 (10 patients) ve for anti-CCP (8 cases)
    5.9 gt100 U
  • 9/10 patients with ve anti-CCP had non-erosive
    arthritis

Annals of the Rheumatic Diseases 200564114-117
13
Anti-CCP in Psoriatic Arthritis
  • Serum samples of 192 PsA patients
  • Test EuroDiagnostica ELISA
  • Cut-off at a specificity-level of gt/ 98.5 (42
    U/ml)
  • Anti-CCP antibodies were found in 15/192 (7.8)
    patients. Thirteen samples of 15 patients with
    anti-CCP2 were also positive for anti-pepA or
    pepB antibodies.

Vander Cruyssen B Ann Rheum Dis. 2005
14
Anti-CCP in RA and non-RA rheumatic diseases
Ann Rheum Dis 200362870-874
15
Points
  • Definition
  • Role in diagnosing RA
  • Prognostic role in RA

16
Anti-CCP and disease course
  • 242 patients with lt1 year onset RA (clinical Dx)
  • F/up 3 yrs
  • Outcome variables (at different time points)
  • ESR, CRP
  • DAS 28
  • PGA
  • HAQ
  • anti-CCP2 (Euro-Diagnostica, cut-off 25 U/ml)

Kastbom A et al, Ann Rheum Dis 2004631085
17
Kastbom A et al, Ann Rheum Dis 2004631085
18
Anti-CCP and erosions in RA
Lee Schur, ARD 2003
19
Patients description
  • Pain (VAS 0-100) 57.5 ? 22
  • EMS (min) 84.9 ? 79.4
  • TJC 21.7 ? 10.5
  • SJC 9.0 ? 5.9
  • ESR 40.2 ? 28.5
  • Values are mean ? SD

Meyer, Annals of the Rheumatic Diseases
200362120
20
Meyer, Annals of the Rheumatic Diseases
200362120
21
Titer
Our own, still incomplete and unpublished data
seem to indicate that high titers of anti-CCP (gt5
times cut-off) correlate somewhat more strongly
with erosive disease than lower titers.
Antibodies to cyclic citrullinated peptides are
specific for the diagnosis and prognosis of
(early) rheumatoid arthritis Walther J. van
Venrooij, Albert J.W. Zendman, Suzanne
Nijenhuis,Erik R. Vossenaar, Allan Wiik, and Ger
J.M. Pruijn Elia Journal, November 2004
22
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