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van de Loo FAJ. Soluble IL-18 receptor complex: a new star in the firmament of rheumatoid arthritis diagnosis? Arthritis Res Ther 2011; 13:111. [PMID: 21542890 PMCID: PMC3132051 DOI: 10.1186/ar3308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
It has long been recognized that laboratory tests are useful in the diagnosis of disease and to monitor treatment outcome. Their performance has become even more demanding with the development of personalized medicine. In patients with rheumatoid arthritis (RA) the standard biochemical tests measure serological markers of disease, such as C-reactive protein, and RA-associated auto-antibodies, such as rheumatoid factor and anti-citrullinated protein antibodies. The information obtained from these markers does not, however, provide a complete picture of the disease and treatment efficacy. New biomarkers based on cytokine receptor complexes are promising for RA theragnostics.
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Affiliation(s)
- Fons AJ van de Loo
- Rheumatology Research & Advanced Therapeutics, Department of Rheumatology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 28, 6525 GA Nijmegen, The Netherlands
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102
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Teramoto S, Komiya K, Akashi S, Kawashima M. A clue to diagnosing connective tissue disease-associated interstitial lung disease. Chest 2011; 139:722. [PMID: 21362663 DOI: 10.1378/chest.10-2381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Shinji Teramoto
- Department of Respiratory Medicine, National Hospital Organization, Tokyo National Hospital, Tokyo, Japan.
| | - Kosaku Komiya
- Department of Respiratory Medicine, Oita University Hospital, Oita, Japan
| | - Shunsuke Akashi
- Department of Respiratory Medicine, National Hospital Organization, Tokyo National Hospital, Tokyo, Japan
| | - Masahiro Kawashima
- Department of Respiratory Medicine, National Hospital Organization, Tokyo National Hospital, Tokyo, Japan
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103
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Puszczewicz M, Iwaszkiewicz C. Role of anti-citrullinated protein antibodies in diagnosis and prognosis of rheumatoid arthritis. Arch Med Sci 2011; 7:189-94. [PMID: 22291756 PMCID: PMC3258718 DOI: 10.5114/aoms.2011.22067] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 10/19/2010] [Accepted: 12/01/2010] [Indexed: 11/21/2022] Open
Abstract
Antibodies to citrullinated proteins/peptides (ACPAs) are the second serological marker to have recently been included in the 2010 ACR/EULAR Rheumatoid Arthritis (RA) Classification Criteria, which are focused on early diagnosis and therapy. This review discusses their history and some clinical aspects of ACPAs, focusing on the diagnostic utility of anti-cyclic citrullinated peptide (anti-CCP) antibodies as a marker of RA as compared to the widely used rheumatoid factor (RF). Simultaneously, this review aims to raise physician awareness and interest in anti-citrullinated vimentin antibody (anti-Sa/anti-MCV), another member of the ACPA family, which appears to have a better predictive value as a marker of RA than anti-CCP or RF and correlates closely with disease activity and therapeutic response among patients with RA.
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Affiliation(s)
- Mariusz Puszczewicz
- Department of Rheumatology and Internal Medicine, Poznań University of Medical Sciences, Poznań, Poland
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104
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Svärd A, Kastbom A, Söderlin MK, Reckner-Olsson Å, Skogh T. A comparison between IgG- and IgA-class antibodies to cyclic citrullinated peptides and to modified citrullinated vimentin in early rheumatoid arthritis and very early arthritis. J Rheumatol 2011; 38:1265-72. [PMID: 21459947 DOI: 10.3899/jrheum.101086] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Because of their slightly higher sensitivity, it has been argued that antibodies to modified citrullinated vimentin (anti-MCV) are superior to antibodies to cyclic citrullinated peptides (anti-CCP), while others claim that anti-CCP is preferable because of higher diagnostic specificity for rheumatoid arthritis (RA). We evaluated IgG- and IgA-class anti-MCV and anti-CCP as diagnostic and prognostic markers in early arthritis. METHODS Two Swedish arthritis populations were examined: 215 patients with early RA (≤ 12 months' duration) from the Swedish TIRA-1 cohort, and 69 patients with very early arthritis (≤ 3 months' duration) from the Kronoberg Arthritis Incidence cohort, in which 22% were diagnosed with RA. IgG anti-CCP and anti-MCV antibodies were analyzed with commercial kits. These tests were modified for IgA-class antibody detection. Results were related to disease course, smoking habits, and shared epitope status. RESULTS In the TIRA-1 cohort, occurrence of IgG anti-MCV and IgG anti-CCP showed a 93% overlap, although IgG anti-MCV had higher diagnostic sensitivity. Twenty-four percent tested positive for IgA anti-MCV compared to 29% for IgA anti-CCP. In the Kronoberg Arthritis Incidence cohort, 15% tested positive for IgG anti-MCV and 6% for IgA anti-MCV, compared to 10% positive for IgG anti-CCP and 3% positive for IgA anti-CCP, revealing that anti-CCP had higher diagnostic specificity for RA. As previously reported for IgA anti-CCP, IgA anti-MCV antibodies occurred in a small proportion of high-level IgG antibody-positive sera and were associated with a more aggressive disease course. Smokers were more often positive for antibodies to citrullinated proteins, most strikingly among the patients who were IgA anti-MCV-positive. CONCLUSION The occurrences of IgG-class anti-MCV and anti-CCP in early RA largely overlap. The sensitivity of anti-MCV is slightly higher, while the diagnostic specificity is higher for anti-CCP. In both instances a positive test predicts an unfavorable disease course, possibly slightly more so for anti-MCV. Although associated with a more active disease over time, IgA-class anti-CCP or anti-MCV do not add any diagnostic advantage.
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Affiliation(s)
- Anna Svärd
- Rheumatology Clinic, Falun Hospital, Falun, Sweden.
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106
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Somers K, Geusens P, Elewaut D, De Keyser F, Rummens JL, Coenen M, Blom M, Stinissen P, Somers V. Novel autoantibody markers for early and seronegative rheumatoid arthritis. J Autoimmun 2011; 36:33-46. [PMID: 21071175 DOI: 10.1016/j.jaut.2010.10.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 09/17/2010] [Accepted: 10/10/2010] [Indexed: 12/17/2022]
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107
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Muñoz-Ortego J, Lara J, Navarro Ferrando JT. [A 21 year-old woman with fever, arthralgia and leucocitosis]. Med Clin (Barc) 2011; 136:31-7. [PMID: 20889167 DOI: 10.1016/j.medcli.2010.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 07/05/2010] [Indexed: 11/15/2022]
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Mapping of citrullinated fibrinogen B-cell epitopes in rheumatoid arthritis by imaging surface plasmon resonance. Arthritis Res Ther 2010; 12:R219. [PMID: 21182780 PMCID: PMC3046532 DOI: 10.1186/ar3205] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 11/22/2010] [Accepted: 12/23/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Rheumatoid arthritis (RA) frequently involves the loss of tolerance to citrullinated antigens, which may play a role in pathogenicity. Citrullinated fibrinogen is commonly found in inflamed synovial tissue and is a frequent target of autoantibodies in RA patients. To obtain insight into the B-cell response to citrullinated fibrinogen in RA, its autoepitopes were systematically mapped using a new methodology. METHODS Human fibrinogen was citrullinated in vitro by peptidylarginine deiminases (PAD), subjected to proteolysis and the resulting peptides were fractionated by ion exchange chromatography. The peptide composition of the citrullinated peptide-containing fractions was determined by high resolution tandem mass spectrometry. The recognition of these fractions by patient sera was subsequently analyzed by imaging surface plasmon resonance on microarrays. RESULTS In total about two-thirds of the 81 arginines of human fibrinogen were found to be susceptible to citrullination by the human PAD2, the human PAD4 or the rabbit PAD2 enzymes. Citrullination sites were found in all three polypeptide chains of fibrinogen, although the α-chain appeared to contain most of them. The analysis of 98 anti-citrullinated protein antibody-positive RA sera using the new methodology allowed the identification of three major citrullinated epitope regions in human fibrinogen, two in the α- and one in the β-chain. CONCLUSIONS A comprehensive overview of citrullination sites in human fibrinogen was generated. The multiplex analysis of peptide fractions derived from a post-translationally modified protein, characterized by mass spectrometry, with patient sera provides a versatile system for mapping modified amino acid-containing epitopes. The citrullinated epitopes of human fibrinogen most efficiently recognized by RA autoantibodies are confined to three regions of its polypeptides.
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ZHAO JINXIA, LIU XIANGYUAN, WANG ZHIMIN, LIU RUI, LI ZHANGUO. Is It Necessary to Combine Detection of Anticitrullinated Protein Antibodies in the Diagnosis of Rheumatoid Arthritis? J Rheumatol 2010; 37:2462-5. [DOI: 10.3899/jrheum.100399] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.Antibodies against citrulline-containing epitopes, such as antiperinuclear factor (APF), antikeratin antibodies (AKA), antifilaggrin antibodies, and anticyclic citrullinated peptide (anti-CCP) antibodies, are specific in rheumatoid arthritis (RA). Detection of APF, AKA, and anti-CCP has been widely used in clinical practice. However, studies on combined detection of these anti citrullinated protein antibodies (ACPA) in the significance of diagnosing RA have been limited. We aimed to detect APF, AKA, and anti-CCP antibodies and to evaluate the significance of combined detection of these ACPA in RA.Methods.A total of 551 patients with arthritic disorders, 304 with RA and 247 with other rheumatic diseases, were selected at the Department of Rheumatology and Immunology during the past 2 years. AKA and APF were tested by indirect immunofluorescence assay. Anti-CCP was detected using the second-generation ELISA kit.Results.The sensitivities of anti-CCP, AKA, and APF tests for RA were 76.2%, 43.4%, and 34.5%, respectively, while the specificities were 96.0%, 98.4%, and 99.6%. The combination of anti-CCP, AKA, and APF positivity had the highest specificity (100%), but it yielded a low sensitivity (28.3%). When 2 of the 3 ACPA were positive, the sensitivity and specificity were 48.4% and 99.2%, respectively. When either anti-CCP or AKA or APF was positive, sensitivity increased to 77.3%, but specificity decreased to 94.7%.Conclusion.Anti-CCP was the most valuable marker in the diagnosis of RA, among the 3 ACPA. Combined detection of anti-CCP, AKA, and APF did not increase the diagnostic capability for RA.
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The influence of anti-cyclic citrullinated peptide on anticentromere antibody-positive rheumatoid arthritis patients: authors' response. Arthritis Res Ther 2010. [PMCID: PMC2991019 DOI: 10.1186/ar3154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Cader MZ, Filer AD, Buckley CD, Raza K. The relationship between the presence of anti-cyclic citrullinated peptide antibodies and clinical phenotype in very early rheumatoid arthritis. BMC Musculoskelet Disord 2010; 11:187. [PMID: 20731815 PMCID: PMC2936346 DOI: 10.1186/1471-2474-11-187] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 08/23/2010] [Indexed: 11/10/2022] Open
Abstract
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. Methods Patients were recruited from the Birmingham early inflammatory arthritis clinic. Participants were included in the current study if they presented within 3 months of symptom onset and fulfilled 1987 ACR criteria for RA at some point during an 18 month follow-up. Data were collected on demographic variables, joint symptoms and tender (n = 68) and swollen (n = 66) joint counts. CRP, ESR, rheumatoid factor and anti-CCP2 status were measured. Results 92 patients were included (48 anti-CCP positive). The anti-CCP positive and negative groups were comparable in terms of demographic variables, inflammatory markers, joint counts and 1987 ACR classification criteria, except that more anti-CCP positive patients were rheumatoid factor positive (83.3% vs. 11.4%, p < 0.01). There was no significant difference in the pattern of joint involvement, except for an increased prevalence of knee joint swelling in anti-CCP positive patients (42.9% vs. 22.2%, p = 0.03). Conclusions Patients with and without anti-CCP antibodies present in a similar way, even within three months of clinically apparent disease that eventually develops into RA.
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Affiliation(s)
- Mohammed Z Cader
- MRC Centre for Immune Regulation, School of Immunity and Infection, The University of Birmingham, Birmingham, UK
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112
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Wiik AS, van Venrooij WJ, Pruijn GJM. All you wanted to know about anti-CCP but were afraid to ask. Autoimmun Rev 2010; 10:90-3. [PMID: 20727426 DOI: 10.1016/j.autrev.2010.08.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2010] [Indexed: 12/29/2022]
Abstract
The most specific biomarker associated with the diagnosis of rheumatoid arthritis (RA) is autoantibodies to citrullinated peptides/proteins (ACPA). Though recognized as an important marker of progressive erosive disease its use has been hampered by doubt about what is a positive versus a negative reaction in the several assays that have become available commercially. This review intends to indicate that the CCP2 assay has the highest specificity and sensitivity in stratified studies that encompass sera from RA patients and non-RA inflammatory controls compared to other ACPA tests. Still, larger and strictly stratified studies are highly warranted to substantiate this conclusion.
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Affiliation(s)
- Allan S Wiik
- Department of Clinical Biochemistry and Immunology, Statens Serum Institut, Copenhagen, Denmark.
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113
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Wu T, Sajitharan D, Mohan C. Biomarkers of rheumatoid arthritis: recent progress. ACTA ACUST UNITED AC 2010; 4:293-305. [DOI: 10.1517/17530059.2010.492828] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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114
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Goeldner I, Skare TL, de Messias Reason IT, Nisihara RM, Silva MB, Utiyama SRDR. Anti-cyclic citrullinated peptide antibodies and rheumatoid factor in rheumatoid arthritis patients and relatives from Brazil. Rheumatology (Oxford) 2010; 49:1590-3. [PMID: 20457731 DOI: 10.1093/rheumatology/keq134] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To evaluate the prevalence of anti-cyclic citrullinated peptide (anti-CCP) antibodies and RF in RA patients and their relatives from Southern Brazil. METHODS Anti-CCP2 and IgM-RF were evaluated in 156 RA patients and 200 relatives. Sera from 100 healthy unrelated individuals were used as control. The anti-CCP2 was detected by ELISA and the IgM-RF using the latex agglutination test. RESULTS We identified 117 anti-CCP2 (75%)-positive and 106 RF (67.9%)-positive patients. Anti-CCP2 was increased in relatives (5.5%; 11/200) when compared with unrelated individuals (1%; P = 0.050). Titre of anti-CCP2 in RA patients did not differ from relatives [140.4 (75.7) vs 115.6 (84.2) U, respectively; P = 0.30]. Positive relatives were younger than patients for anti-CCP2 (P = 0.0081), RF (P < 0.001) and both concomitantly (P = 0.012), and although there was no difference for anti-CCP2 positivity according to gender, increased RF positivity and concomitant anti-CCP2/RF were observed in the female relatives (P = 0.067 and 0.082, respectively). No difference regarding the relative degree of tobacco use in relatives was detected. Among the 11 anti-CCP2-positive relatives, 2 females had RA diagnosis established and 6 individuals presented with joint symptoms suggestive of RA. CONCLUSION The results demonstrate a significant positivity of anti-CCP2 in relatives of RA patients from Brazil and reinforce the importance of serological tools to identify undiagnosed RA.
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Affiliation(s)
- Isabela Goeldner
- Laboratory of Immunopathology, Clinical Hospital, Federal University of Paraná, Curitiba, Paraná, Brazil
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115
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Smith KGC, Clatworthy MR. FcgammaRIIB in autoimmunity and infection: evolutionary and therapeutic implications. Nat Rev Immunol 2010; 10:328-43. [PMID: 20414206 PMCID: PMC4148599 DOI: 10.1038/nri2762] [Citation(s) in RCA: 382] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
FcgammaRIIB is the only inhibitory Fc receptor. It controls many aspects of immune and inflammatory responses, and variation in the gene encoding this protein has long been associated with susceptibility to autoimmune disease, particularly systemic lupus erythematosus (SLE). FcgammaRIIB is also involved in the complex regulation of defence against infection. A loss-of-function polymorphism in FcgammaRIIB protects against severe malaria, the investigation of which is beginning to clarify the evolutionary pressures that drive ethnic variation in autoimmunity. Our increased understanding of the function of FcgammaRIIB also has potentially far-reaching therapeutic implications, being involved in the mechanism of action of intravenous immunoglobulin, controlling the efficacy of monoclonal antibody therapy and providing a direct therapeutic target.
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Affiliation(s)
- Kenneth G C Smith
- Cambridge Institute for Medical Research and the Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge CB2 0XY, UK.
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116
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Anticyclic citrullinated peptide autoantibodies in systemic lupus erythematosus. Rheumatol Int 2010; 31:765-7. [PMID: 21611890 DOI: 10.1007/s00296-010-1374-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 02/06/2010] [Indexed: 02/07/2023]
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117
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Pruijn GJ, Wiik A, van Venrooij WJ. The use of citrullinated peptides and proteins for the diagnosis of rheumatoid arthritis. Arthritis Res Ther 2010; 12:203. [PMID: 20236483 PMCID: PMC2875630 DOI: 10.1186/ar2903] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The presence or absence of antibodies to citrullinated peptides/proteins (ACPA) is an important parameter that helps a clinician set a diagnosis of early rheumatoid arthritis and, hence, initiate treatment. There are several commercial tests available to measure ACPA levels, although it can be difficult to decide what the best test for a given clinical question is. We analyzed literature data in which the diagnostic and other properties of various ACPA tests are compared. The results show that for diagnostic purposes the CCP2 test has the highest specificity, the highest sensitivity in stratified studies and the highest positive predictive value. For the prediction of future joint destruction the CCP2, MCV, and CCP3 tests may be used. The ability to predict the likelihood of not achieving sustained disease-modifying antirheumatic drug-free remission was highest for the CCP2 test. Finally, the levels of anti-CCP2 and anti-CCP3 (and possibly anti-mutated citrullinated vimentin) in rheumatoid arthritis patients are not significantly influenced by TNFalpha blocking agents.
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Affiliation(s)
- Ger Jm Pruijn
- Department of Biomolecular Chemistry 271, Nijmegen Center for Molecular Life Sciences, Institute for Molecules and Materials, Radboud University Nijmegen, PO Box 9101, NL-6500 HB Nijmegen, the Netherlands.
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118
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Mahler M, Fritzler MJ. Epitope specificity and significance in systemic autoimmune diseases. Ann N Y Acad Sci 2010; 1183:267-87. [DOI: 10.1111/j.1749-6632.2009.05127.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Singh U, Vishwanath A, Verma PK, Singh NK, Shukla RC, Singh S, Singh S, Sonkar GK. Is rheumatoid factor still a superior test for the diagnosis of rheumatoid arthritis? Rheumatol Int 2010; 30:1115-9. [PMID: 20058015 DOI: 10.1007/s00296-009-1338-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Accepted: 12/20/2009] [Indexed: 10/20/2022]
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Tayar JH, Suarez-Almazor ME. New understanding and approaches to treatment in rheumatoid arthritis. Br Med Bull 2010; 94:201-14. [PMID: 20200013 DOI: 10.1093/bmb/ldq007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Rheumatoid arthritis (RA) is the most common autoimmune inflammatory polyarthritis. Significant advances in the understanding of its pathogenesis have led in the past two decades to major advancement in its therapy. We used data from articles in Cochrane Database of Systematic Reviews on 'rheumatoid arthritis', meta-analyses and randomized controlled trials on adult RA (age >19 years) published in English within the past 5 years and identified in PubMed, and other key papers on management of RA. Appropriate, early and aggressive therapy is required for confirmed active cases of RA. The choice of disease-modifying drugs and different combinations, especially the newer biologic agents in regards of their early and long-term usage remains debated because of high costs and long-term safety concerns. Development of newer biologic agents working on different pathways of inflammation is underway in different stages. It remains to be determined how and when each of these agents will fit in the overall management of RA. Furthermore, post-marketing surveillance of the safety and response sustainability of these drugs is warranted.
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Affiliation(s)
- Jean H Tayar
- Department of General Internal Medicine, AT and EC, Section of Rheumatology, The University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA.
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121
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Komiya K, Teramoto S, Kurosaki Y, Kashizaki F, Kawashima M, Masuda K, Akagawa S, Hebisawa A, Ishii H, Kadota JI. Organizing pneumonia with a positive result for anti-CCP antibodies as the first clinical presentation of rheumatoid arthritis. Intern Med 2010; 49:1605-7. [PMID: 20686298 DOI: 10.2169/internalmedicine.49.3609] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report an 86-year-old woman who presented with organizing pneumonia (OP) with a positive anti-cyclic citrullinated peptide (anti-CCP) antibodies as the first manifestation of rheumatoid arthritis (RA). She experienced dyspnea, chest X-ray showed diffuse alveolar exudates indicated OP histologically. Although she did not present with articular symptoms initially, anti-CCP antibodies measured for differentiation of RA were positive. Eight months later, she showed representative manifestations of RA. Even though OP following joint involvement is frequent in RA, in rare cases it could be the first manifestation. This is the first case showing OP with a positive result for anti-CCP antibodies as the first manifestation of RA.
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Affiliation(s)
- Kosaku Komiya
- Department of Respiratory Medicine, National Hospital Organization, Tokyo National Hospital.
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122
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Stanich JA, Carter JD, Whittum-Hudson J, Hudson AP. Rheumatoid arthritis: Disease or syndrome? Open Access Rheumatol 2009; 1:179-192. [PMID: 27789990 PMCID: PMC5074722 DOI: 10.2147/oarrr.s7680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Rheumatoid arthritis (RA) has been described in the medical literature for over two hundred years, but its etiology remains unknown. RA displays phenotypic heterogeneity, and it is a relatively prevalent clinical entity: it affects approximately 1% of the population, resulting in enormous pathologic sequelae. Earlier studies targeting the cause(s) of RA suggested potential infectious involvement, whereas more recent reports have focused on a genetic origin of the disease. However, neither infection nor genetics, nor any other single factor is currently accepted as causative of RA. In this article we review studies relating to the etiology of RA, and those of several related matters, and we conclude that the literature indeed does provide insight into the causes underlying the initiation of RA pathogenesis. Briefly, given the remarkable phenotypic variation of RA, especially in its early stages, as well as a number of other characteristics of the condition, we contend that RA is not a discrete clinical entity with a single etiological source. Rather, we argue that it represents a common clinical endpoint for various starting points, each of which is largely guided by as yet poorly understood aspects of the genetic background of the affected individual. Adoption of this alternative view of the origin of RA will have significant consequences for future research and for development of new therapeutic interventions for this burdensome condition.
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Affiliation(s)
- Jessica A Stanich
- Department of Immunology and Microbiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - John D Carter
- Division of Rheumatology, Department of Internal Medicine, University of South Florida School of Medicine, Tampa, FL, USA
| | - Judith Whittum-Hudson
- Department of Immunology and Microbiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Alan P Hudson
- Department of Immunology and Microbiology, Wayne State University School of Medicine, Detroit, MI, USA
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van Bavel CC, Dieker J, Muller S, Briand JP, Monestier M, Berden JH, van der Vlag J. Apoptosis-associated acetylation on histone H2B is an epitope for lupus autoantibodies. Mol Immunol 2009; 47:511-6. [DOI: 10.1016/j.molimm.2009.08.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 08/11/2009] [Accepted: 08/12/2009] [Indexed: 10/20/2022]
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Stenberg P, Roth B, Wollheim FA. Peptidylarginine deiminases and the pathogenesis of rheumatoid arthritis: a reflection of the involvement of transglutaminase in coeliac disease. Eur J Intern Med 2009; 20:749-55. [PMID: 19892302 DOI: 10.1016/j.ejim.2009.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 08/17/2009] [Accepted: 08/20/2009] [Indexed: 01/13/2023]
Abstract
Post-translational modifications are associated with certain autoimmune diseases. For example, in the initial steps of coeliac disease (CD), transglutaminase type 2 (TG2) catalyzes a post-translational deamidation of specific glutamine residues in dietary gluten, resulting in antibodies against both modified gliadin and against TG2. Anti-TG2 has become a specific biomarker for CD. In rheumatoid arthritis (RA), the presence of antibodies against citrullinated peptides (ACPA) characterizes a distinct subset of this inflammatory disorder. Moreover, antibodies against the enzyme that catalyzes the citrullination (peptidylarginine deiminase; PAD) are found in RA. Their relation to disease severity indicates a possible pathogenetic role. Thus, in two major autoimmune diseases (CD and RA), antibodies are present against a post-translationally modified substrate and against the calcium-dependent thiol-enzyme (TG2 and PAD, respectively) responsible for the modification. This review highlights the similarities between the TGs and the PADs and their putative pathogenetic roles in autoimmune diseases. Possible mechanisms of the effects of cigarette smoking and alcohol consumption on RA are discussed. By reflecting the progress in CD, the pathogenesis of ACPA-positive RA can be hypothesized where expression and regulation of PADs play significant roles. Indeed, autoimmune diseases should be studied collectively as well as individually. The new insight may lead towards innovative pharmacotherapeutic principles.
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Affiliation(s)
- Pål Stenberg
- Lund University, Department of Clinical Sciences, Malmö, Clinical Coagulation Research Unit, Malmö University Hospital, Malmö, Sweden.
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125
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Salgado FJ, Vázquez S, Iglesias A, Pérez-Díaz A, Mera-Varela A, Arias P, Nogueira M. Application of thiophilic chromatography to deplete serum immunoglobulins in sample preparation for bidimensional electrophoresis. Anal Chim Acta 2009; 658:18-31. [PMID: 20082770 DOI: 10.1016/j.aca.2009.10.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 10/29/2009] [Accepted: 10/30/2009] [Indexed: 01/05/2023]
Abstract
Serum is a typical sample for non-invasive studies in clinical research. Its proteome characterization is challenging, since requires extensive protein depletion. Methods used nowadays for removal of high-abundance proteins are expensive or show quite often a low loading capacity, which has strong repercussions on the number of samples and replicates per analysis. In order to deplete immunoglobulins (Igs) and albumin (HSA) from 1 mL serum samples, we have developed a protocol based on a combination of thiophilic chromatography, not previously used in clinical proteomics, and a HSA-specific resin. Ig/HSA-depleted samples, immunoglobulinome and albuminone were analyzed by 2-DE. Thiophilic chromatography, coupled with HSA-depletion, allows a good 2-DE resolution as well as the visualization of new spots. Moreover, it yields enough protein to evaluate technical variability and facilitate subsequent protein identification. To validate the protocol, we carried out a preliminary comparative study between triplicate Igs/HSA-depleted serum samples from healthy control individuals and recently diagnosed/untreated rheumatoid arthritis (RA) patients. RA patients showed several acute phase proteins, as well as additional serum proteins, differentially and significantly regulated. Therefore, thiophilic chromatography can be used as an efficient and economical method in 2-DE to deplete immunoglobulins from large human serum samples before a more extensive fractioning.
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Affiliation(s)
- Francisco J Salgado
- Department of Biochemistry and Molecular Biology, Biological Research Centre of University of Santiago/CIBUS, University of Santiago de Compostela, Lope Gómez de Marzoa, 15782 Santiago de Compostela, A Coruña, Spain.
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126
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Somers K, Stinissen P, Somers V. Optimization of High-throughput Autoantibody Profiling for the Discovery of Novel Antigenic Targets in Rheumatoid Arthritis. Ann N Y Acad Sci 2009; 1173:92-102. [PMID: 19758137 DOI: 10.1111/j.1749-6632.2009.04654.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Klaartje Somers
- Hasselt University, Biomedical Research Institute, and Transnationale Universiteit Limburg, School of Life Sciences, Agoralaan, Building C, 3590 Diepenbeek, Belgium
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127
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Galligan CL, Siebert JC, Siminovitch KA, Keystone EC, Bykerk V, Perez OD, Fish EN. Multiparameter phospho-flow analysis of lymphocytes in early rheumatoid arthritis: implications for diagnosis and monitoring drug therapy. PLoS One 2009; 4:e6703. [PMID: 19693272 PMCID: PMC2724743 DOI: 10.1371/journal.pone.0006703] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Accepted: 07/06/2009] [Indexed: 11/24/2022] Open
Abstract
Background The precise mechanisms involved in the initiation and progression of rheumatoid arthritis (RA) are not known. Early stages of RA often have non-specific symptoms, delaying diagnosis and therapy. Additionally, there are currently no established means to predict clinical responsiveness to therapy. Immune cell activation is a critical component therefore we examined the cellular activation of peripheral blood mononuclear cells (PBMCs) in the early stages of RA, in order to develop a novel diagnostic modality. Methods and Findings PBMCs were isolated from individuals diagnosed with early RA (ERA) (n = 38), longstanding RA (n = 10), osteoarthritis (OA) (n = 19) and from healthy individuals (n = 10). PBMCs were examined for activation of 15 signaling effectors, using phosphorylation status as a measure of activation in immunophenotyped cells, by flow cytometry (phospho-flow). CD3+CD4+, CD3+CD8+ and CD20+ cells isolated from patients with ERA, RA and OA exhibited activation of multiple phospho-epitopes. ERA patient PBMCs showed a bias towards phosphorylation-activation in the CD4+ and CD20+ compartments compared to OA PBMCs, where phospho-activation was primarily observed in CD8+ cells. The ratio of phospho (p)-AKT/p-p38 was significantly elevated in patients with ERA and may have diagnostic potential. The mean fluorescent intensity (MFI) levels for p-AKT and p-H3 in CD4+, CD8+ and CD20+ T cells correlated directly with physician global assessment scores (MDGA) and DAS (disease activity score). Stratification by medications revealed that patients receiving leflunomide, systemic steroids or anti-TNF therapy had significant reductions in phospho-specific activation compared with patients not receiving these therapies. Correlative trends between medication-associated reductions in the levels of phosphorylation of specific signaling effectors and lower disease activity were observed. Conclusions Phospho-flow analysis identified phosphorylation-activation of specific signaling effectors in the PB from patients with ERA. Notably, phosphorylation of these signaling effectors did not distinguish ERA from late RA, suggesting that the activation status of discrete cell populations is already established early in disease. However, when the ratio of MFI values for p-AKT and p-p38 is >1.5, there is a high likelihood of having a diagnosis of RA. Our results suggest that longitudinal sampling of patients undergoing therapy may result in phospho-signatures that are predictive of drug responsiveness.
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Affiliation(s)
- Carole L. Galligan
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Janet C. Siebert
- CytoAnalytics, Analytical Services, Denver, Colorado, United States of America
| | - Katherine A. Siminovitch
- Mount Sinai Hospital Samuel Lunenfeld and Toronto Hospital Research Institutes, Toronto, Ontario, Canada
| | - Edward C. Keystone
- University of Toronto and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Vivian Bykerk
- University of Toronto and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Omar D. Perez
- The Baxter Laboratory for Genetic Pharmacology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Eleanor N. Fish
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
- * E-mail:
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Abstract
Low-affinity Fcgamma receptors (FcgammaRs) mediate the effects of immunoglobulin G (IgG) antibodies on leukocytes, including recruitment to inflammatory lesions, phagocytosis, antibody-dependent cellular cytotoxicity, release of inflammatory mediators and regulation of B cell activation. These functions are an important part of the mammalian response to infection, but if deployed inappropriately can cause autoimmune disease. Although most FcgammaRs are activatory, there is also an inhibitory FcgammaR that, when bound to IgG immune complexes, is able to downregulate the effects of both the activatory FcgammaRs and the B cell receptor. This review discusses the role of the low-affinity FcgammaRs in a balanced immune response and how perturbations in FcgammaR function result in susceptibility to infection or autoimmunity.
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Sheane BJ, Beddy P, O'Connor M, Miller S, Cunnane G. Targeted ultrasound of the fifth metatarsophalangeal joint in an early inflammatory arthritis cohort. ACTA ACUST UNITED AC 2009; 61:1004-8. [DOI: 10.1002/art.24564] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Immune Complexes and Complement in Serum and Synovial Fluid of Rheumatoid Arthritis Patients. J Med Biochem 2009. [DOI: 10.2478/v10011-009-0016-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Immune Complexes and Complement in Serum and Synovial Fluid of Rheumatoid Arthritis PatientsRheumatoid arthritis (RA) is predominantly an intraarticular inflammatory and autoimmune disease that involves different autoantibodies and effector mechanisms. The aim of the study was to determine the utility of Circulating Immune Complexes (CIC) and complement components (C3c, C4) as possible markers for the disease activity in laboratory diagnostics. In a cross-section study 59 patients, according to the clinical criteria, were categorized into two groups: group with moderate (MA, n=24), and group with severe activity (SA, n=35) of RA. The concentration of CIC, C3c and C4 in sera (S) and synovial fluids (SF) was examined by an immunonephelometric method in both groups and compared with values in the control group (n=15) of patients with lesions of the menisci. Obtained results showed that there was no statistical significance in the values of C3c and C4, in both biological fluids, among all tested groups. Significant differences were found in the levels of CIC in both fluids, while testing the parameters (× ± SD, IU/mL) in the sera of groups with SA and MA of RA: 7.43 ± 13.40; 3.01 ± 2.92 (p<0.05) and SF: 13.47 ± 21.1, 5.33 ± 7.53 (p<0.001), respectively. These differences were higher between the group with SA and CG. Results for the concentrations of CIC were significantly higher in SF compared to sera: in the RA group with SA by 77% and group with MA by about 82%. These data could provide a confirmation of the hypothesis about local, intraarticular autoantibodies and subsequent CIC production. It can be concluded that the examination of CIC concentration in serum, and where it is possible in SF, is a useful marker of disease activity in RA patients, in contrast to the tested components of the complement. This statement does not exclude their consumption within immune effector mechanisms, but elicits the possibility that lower molecular fragments (C3d, C4d), as well as the novel activation products, could be better disease activity markers in RA patients.
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131
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Szodoray P, Szabó Z, Kapitány A, Gyetvai A, Lakos G, Szántó S, Szücs G, Szekanecz Z. Anti-citrullinated protein/peptide autoantibodies in association with genetic and environmental factors as indicators of disease outcome in rheumatoid arthritis. Autoimmun Rev 2009; 9:140-3. [PMID: 19427413 DOI: 10.1016/j.autrev.2009.04.006] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 04/30/2009] [Indexed: 12/19/2022]
Abstract
Anti-citrullinated protein/peptide antibodies (ACPA) have recently emerged as sensitive and specific serological markers of rheumatoid arthritis (RA), providing superior alternative of the rheumatoid factor (RF) test in the laboratory diagnostics of RA. Citrullination is a post-translational modification of arginine by deimination, physiologically occurring during apoptosis, inflammation or keratinization. The presence of several citrullinated proteins has been demonstrated in the RA synovium. The identification of citrullinated epitopes as targets led to the development of the first and later second-generation anti-cyclic citrullinated peptide (anti-CCP) antibody assays. The anti-Sa antibody has been identified a decade ago; however, recent studies confirmed that anti-Sa is directed against citrullinated vimentin. The determination of ACPA may have important prognostic significance, since ACPA production can precede the onset of clinical RA symptoms by years. ACPA(+) individuals with early, undifferentiated arthritis may have higher risk to develop RA. ACPA has important prognostic role during the progression of RA and it has also been associated with pronounced radiographic progression. ACPA production has been associated with several genetic predisposing factors, including HLA-DRB1 and PTPN22 1858T alleles, as well as with environmental and lifestyle-related factors, primarily smoking and possibly, the use of oral contraceptives and excessive caffeine intake. Thus, the assessment of ACPA, in addition to clinical, radiographic and genetic outcome measures may be important to assess disease prognosis and aids to design effective, early therapeutic strategies.
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Affiliation(s)
- Péter Szodoray
- Immunobiological Laboratory, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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van Venrooij WJ, Pruijn GJM. An important step towards completing the rheumatoid arthritis cycle. Arthritis Res Ther 2008; 10:117. [PMID: 18828887 PMCID: PMC2592789 DOI: 10.1186/ar2504] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
In the previous issue of Arthritis Research & Therapy data are presented showing that circulating immune complexes containing citrullinated fibrin(ogen) are present in anti-citrullinated protein antibody-positive rheumatoid arthritis patients, and that such immune complexes co-localize with complement factor C3 in the rheumatoid synovium. These results corroborate the idea that citrullination is intimately involved in the pathophysiology of rheumatoid arthritis and complete our model (the rheumatoid arthritis cycle) for the development and chronic nature of this disease.
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