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Hernández-Huirache HG, Armenta-Medina D, Rodea-Montero ER. Clinical, Immunological and Inflammatory Characteristics among Mexican Children with Different Subtypes of Juvenile Idiopathic Arthritis: Exploring the Correlation between Anti-Cyclic Citrullinated Peptide (anti-CCP) and Rheumatoid Factor (RF). Pediatr Rep 2024; 16:151-162. [PMID: 38391002 PMCID: PMC10885026 DOI: 10.3390/pediatric16010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood, affecting one to four of every 1000 children worldwide. It is characterized by joint inflammation lasting more than six weeks in children under 16 years. The aim of this study was to estimate the frequency of JIA subtypes in the Mexican patient population; compare clinical, immunological and inflammation markers by JIA subtype; and examine the correlation between these variables. METHODS We conducted a cross-sectional study of 50 patients with JIA (2-15 years). We estimated the frequency of each JIA subtype, assessed and compared the immunological characteristics (RF, ANA and anti-CCP) by JIA subtype at the time of diagnosis using Kruskal-Wallis or chi-square tests, and calculated Spearman correlation coefficients between the assessments. RESULTS Our analysis included 50 patients, 29 (58%) girls and 21 (42%) boys, aged at the time of diagnosis 10.56 ± 3.99 years. The frequencies of JIA subtypes were RF-seropositive polyarthritis (34%), RF-seronegative polyarthritis (28%), systemic arthritis (16%), oligoarthritis (14%) and arthritis-related enthesitis (8%). We found a significant association between sex and JIA subtype (p = 0.014). There was a significant difference in anti-CCP levels by JIA subtype (p < 0.001). We also detected positive correlations between RF and anti-CCP (r = 0.63, p < 0.001) and between age and anti-CCP (r = 0.29, p = 0.041). CONCLUSIONS Our study suggests that the frequency of the polyarticular subtypes of JIA is higher in Mexican children compared to other populations. Our findings highlight the importance of considering the presence of anti-CCP and RF as important criteria when deciding on treatment for JIA patients as elevated levels of these antibodies may indicate early forms of adult rheumatoid arthritis.
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Affiliation(s)
| | - Dagoberto Armenta-Medina
- CONAHCyT Consejo Nacional de Humanidades, Ciencias y Tecnologías, Ciudad de México 03940, Mexico
- INFOTEC Centro de Investigación e Innovación en Tecnologías de la Información y Comunicación, Aguascalientes 20326, Mexico
| | - Edel Rafael Rodea-Montero
- Department of Research, Hospital Regional de Alta Especialidad del Bajío, León 37544, Mexico
- UPIIG, Instituto Politécnico Nacional, Silao de la Victoria 36275, Mexico
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Chen K, Luo M, Lv Y, Luo Z, Yang H. Undervalued and novel roles of heterogeneous nuclear ribonucleoproteins in autoimmune diseases: Resurgence as potential biomarkers and targets. WILEY INTERDISCIPLINARY REVIEWS. RNA 2023; 14:e1806. [PMID: 37365887 DOI: 10.1002/wrna.1806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
Autoimmune diseases are mainly characterized by the abnormal autoreactivity due to the loss of tolerance to specific autoantigens, though multiple pathways associated with the homeostasis of immune responses are involved in initiating or aggravating the conditions. The heterogeneous nuclear ribonucleoproteins (hnRNPs) are a major category of RNA-binding proteins ubiquitously expressed in a multitude of cells and have attracted great attentions especially with their distinctive roles in nucleic acid metabolisms and the pathogenesis in diseases like neurodegenerative disorders and cancers. Nevertheless, the interplay between hnRNPs and autoimmune disorders has not been fully elucidated. Virtually various family members of hnRNPs are increasingly identified as immune players and are pertinent to all kinds of immune-related processes including immune system development and innate or adaptive immune responses. Specifically, hnRNPs have been extensively recognized as autoantigens within and even beyond a myriad of autoimmune diseases, yet their diagnostic and prognostic values are seemingly underestimated. Molecular mimicry, epitope spreading and bystander activation may represent major putative mechanisms underlying the presence of autoantibodies to hnRNPs. Besides, hnRNPs play critical parts in regulating linchpin genes expressions that control genetic susceptibility, disease-linked functional pathways, or immune responses by interacting with other components particularly like microRNAs and long non-coding RNAs, thereby contributing to inflammation and autoimmunity as well as specific disease phenotypes. Therefore, comprehensive unraveling of the roles of hnRNPs is conducive to establishing potential biomarkers and developing better intervention strategies by targeting these hnRNPs in the corresponding disorders. This article is categorized under: RNA in Disease and Development > RNA in Disease RNA Interactions with Proteins and Other Molecules > Protein-RNA Interactions: Functional Implications.
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Affiliation(s)
- Kangzhi Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Mengchuan Luo
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Yuanzhi Lv
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhaohui Luo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Epileptic Disease of Hunan Province, Central South University, Changsha, China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
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Yu K, Dillemans L, Gouwy M, Bessa H, Metzemaekers M, Martens E, Matthys P, Bossuyt X, Verschueren P, Wouters C, De Somer L, Proost P. Novel method to quantify peptidylarginine deiminase activity shows distinct citrullination patterns in rheumatoid and juvenile idiopathic arthritis. Front Immunol 2023; 14:1111465. [PMID: 36793709 PMCID: PMC9923157 DOI: 10.3389/fimmu.2023.1111465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
Introduction Peptidylarginine deiminases (PADs) mediate citrullination, an irreversible posttranslational modification that converts arginine to citrulline residues in proteins. Rheumatoid arthritis (RA) is characterized by unique autoantibodies that recognize citrullinated peptides, which are highly specific for this disease. However, the mechanism preceding the anti-citrulline response remains largely unclear. PAD enzymes are known to fuel the autoimmune response by generating autoreactive epitopes, and sustain local synovial inflammation through neutrophil extracellular trap formation. Therefore, detecting endogenous PAD activity is important to understand the pathogenesis of arthritis. Methods In this study, we improved a fluorescent in vitro assay to enable endogenous PAD activity characterization in complex samples. We combine the use of an in-house synthetic, arginine-rich substrate and a negatively charged dye molecule to visualize enzyme activity. Results This pioneering PAD assay allowed profiling of active citrullination in leukocytes and in local and systemic samples of an arthritis cohort. Our results reveal that RA and juvenile idiopathic arthritis (JIA) synovial fluids display similar levels of PAD activity. In contrast, citrullination was limited in joints of patients suffering from gout or Lyme's disease. Interestingly, in blood, a higher level of extracellular citrullination was only found in anti-CCP-positive RA patients. Discussion Our finding suggests that enhanced synovial PAD activity drives the loss in tolerance towards citrullinated proteins and that systemic citrullination may indicate the risk for developing citrulline-specific autoimmunity.
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Affiliation(s)
- Karen Yu
- Laboratory of Molecular Immunology, Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Luna Dillemans
- Laboratory of Molecular Immunology, Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Mieke Gouwy
- Laboratory of Molecular Immunology, Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Helena Bessa
- Laboratory of Molecular Immunology, Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Mieke Metzemaekers
- Laboratory of Molecular Immunology, Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Erik Martens
- Laboratory of Immunobiology, Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Patrick Matthys
- Laboratory of Immunobiology, Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Xavier Bossuyt
- Laboratory Medicine, University Hospitals Leuven, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Patrick Verschueren
- Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Carine Wouters
- Laboratory of Immunobiology, Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Lien De Somer
- Laboratory of Immunobiology, Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Paul Proost
- Laboratory of Molecular Immunology, Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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Bohn MK, Wilson S, Schneider R, Massamiri Y, Randell EW, Adeli K. Pediatric reference interval verification for 17 specialized immunoassays and cancer markers on the Abbott Alinity i system in the CALIPER cohort of healthy children and adolescents. Clin Chem Lab Med 2023; 61:123-132. [PMID: 36117243 PMCID: PMC9691267 DOI: 10.1515/cclm-2022-0709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/09/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Clinical laboratory investigation of autoimmune, metabolic, and oncologic disorders in children and adolescents relies on appropriateness of reference intervals (RIs). The Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) previously established comprehensive pediatric RIs for specialized immunoassays on the Abbott ARCHITECT system. Herein, we aim to verify performance on new Alinity i assays by evaluating sera collected from healthy children as per Clinical and Laboratory Standards Institute (CLSI) EP-28A3C guidelines. METHODS Precision, linearity, and method comparison experiments were completed for 17 specialized Alinity immunoassays, including cancer antigens, autoimmune peptides, and hormones. Sera collected from healthy children and adolescents (birth-18 years, n=100) were evaluated. CLSI-based verification was completed using previously established CALIPER RIs for ARCHITECT assays as the reference. RESULTS Of 17 specialized immunoassays assays, only anti-cyclic citrullinated peptides (anti-CCP) did not meet acceptable verification criterion (i.e., ≥90% of results within ARCHITECT reference CI). Anti-thyroglobulin, anti-thyroid peroxidase, and carcinoembryonic antigen did not require age-specific consideration beyond one year of age, with 63, 91, and 80% of samples equalling the limit of detection, respectively. Estimates were separated by sex for relevant assays (e.g., sex hormone binding globulin, total and free prostate specific antigen). CONCLUSIONS Findings support transferability of pediatric RIs on ARCHITECT system to the Alinity system for 16 specialized immunoassays in the CALIPER cohort and will be a useful resource for pediatric clinical laboratories using Alinity assays. Further work is needed to establish evidence-based interpretative recommendations for anti-CCP and continue to evaluate pediatric RI acceptability for newly available assay technologies.
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Affiliation(s)
- Mary Kathryn Bohn
- CALIPER Program, Molecular Medicine, Research Institute and the Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Siobhan Wilson
- CALIPER Program, Molecular Medicine, Research Institute and the Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | - Youssef Massamiri
- Clinical Biochemistry, Eastern Health Authority, St. John’s, NL, Canada
| | - Edward W. Randell
- Clinical Biochemistry, Eastern Health Authority, St. John’s, NL, Canada
| | - Khosrow Adeli
- CALIPER Program, Molecular Medicine, Research Institute and the Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Yachie A. Clinical perspectives and therapeutic strategies: pediatric autoinflammatory disease-a multi-faceted approach to fever of unknown origin of childhood. Inflamm Regen 2022; 42:21. [PMID: 35778759 PMCID: PMC9250222 DOI: 10.1186/s41232-022-00204-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/27/2022] [Indexed: 11/25/2022] Open
Abstract
Among the different etiologies for fever of unknown origin in children, infectious diseases are the most frequent final diagnosis, followed by autoimmune diseases and malignancies. Autoinflammatory diseases are relatively rare among children and are frequently overlooked as differential diagnoses for fever of unknown origin. Once the possibility of a particular autoimmune disease is considered by physicians, the diagnosis might be easily made by a genetic approach because many of autoinflammatory diseases are of monogenic origin. To reach the diagnosis, detailed history-taking, precise physical examinations, and cytokine profiling as well as extensive mutation analysis of candidate genes should be undertaken for febrile children. Such the approach will protect the patients, and their family to undergo “diagnostic odyssey” in which unnecessary and sometimes risky diagnostic and therapeutic interventions are taken. This short review discusses the clinical and laboratory features of familial Mediterranean fever and systemic juvenile idiopathic arthritis, as representative illnesses of monogenic and polygenic autoinflammatory diseases, respectively. Cytokine profiling and mutation analyses both help to understand and decipher the heterogeneous pathologies in both disease categories.
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Affiliation(s)
- Akihiro Yachie
- Division of Medical Safety, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
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6
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Sarnik J, Makowska J. Citrullination good or bad guy? Immunobiology 2022; 227:152233. [DOI: 10.1016/j.imbio.2022.152233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 04/11/2022] [Accepted: 05/21/2022] [Indexed: 11/16/2022]
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Storwick JA, Brett A, Buhler K, Chin A, Schmeling H, Johnson N, Fritzler MJ, Choi MY. Prevalence and titres of antinuclear antibodies in juvenile idiopathic arthritis: A systematic review and meta-analysis. Clin Exp Rheumatol 2022; 21:103086. [DOI: 10.1016/j.autrev.2022.103086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/05/2022] [Indexed: 11/02/2022]
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Haas JP, Weimann V, Feist E. [Polyarticular juvenile idiopathic arthritis and rheumatoid arthritis : Common features and differences]. Z Rheumatol 2021; 81:4-13. [PMID: 34713333 DOI: 10.1007/s00393-021-01114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
The spectrum of polyarthritic diseases in childhood as well as in adulthood is wide. In the differential diagnostics different age-related diseases must be taken into consideration. Although, a clear similarity is obvious in all age groups for the classical diseases of polyarticular juvenile idiopathic arthritis and rheumatoid arthritis with respect to the pathogenesis, clinical manifestation and treatment options, this review points to specific differences. The prognosis of polyarthritis in children mainly depends on the joint manifestation, whereas extra-articular comorbidities play a predominant role in the older adult population.
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Affiliation(s)
- Johannes-Peter Haas
- Deutsches Zentrum für Kinder- und Jugendrheumatologie, Zentrum für Schmerztherapie junger Menschen, Kinderklinik Garmisch-Partenkirchen gGmbH, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland.
| | - Vincent Weimann
- Rheumatologie, Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Deutschland
| | - Eugen Feist
- Rheumatologie, Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Deutschland
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Reyhan I, Zhukov OS, Lagier RJ, Bridgforth RF, Williams GJ, Popov JM, Naides SJ, Reiff A. Prevalence and significance of serum 14-3-3η in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2021; 19:14. [PMID: 33593401 PMCID: PMC7885348 DOI: 10.1186/s12969-021-00502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 02/04/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Prompt diagnosis of juvenile idiopathic arthritis (JIA) is important to avoid long term complications. Elevated serum 14-3-3η levels improve the diagnostic sensitivity of rheumatoid factor (RF) and cyclic citrullinated peptide (CCP) antibody in adult rheumatoid arthritis (RA), and have been associated with more severe phenotype. We investigated the prevalence and clinical significance of serum 14-3-3η in different types of JIA. METHODS JIA patients (n = 151) followed by the Pediatric Rheumatology Core at Children's Hospital of Los Angeles were categorized into 5 groups: polyarticular JIA RF+ (PJIA RF+; n = 39), PJIA RF- (n = 39), psoriatic arthritis (PsA; n = 19), enthesitis-related arthritis (ERA; n = 18), and oligoarticular JIA (OJIA [control group]; n = 36). RF, CCP antibody, and 14-3-3η were measured for all patients. 14-3-3η serum levels > 0.2 ng/mL were considered positive. Disease activity was assessed by the Juvenile Arthritis Disease Activity Score-71 (JADAS-71). RESULTS Elevated 14-3-3η levels were detected in 34/151 (23%) patients, and across all groups tested. Most patients with 14-3-3η had titers ≥4 times above the cutoff value. The majority (22, 65%) of 14-3-3η-positive patients were also positive for RF or CCP antibodies, 16 (47%) were positive for all 3, and 12 (35%) were single-positive for 14-3-3η. The highest prevalence of 14-3-3η was in PJIA RF+ patients (49%), followed by OJIA (22%). Positivity for 14-3-3η was not significantly associated with disease activity or age at diagnosis. CONCLUSION Serum 14-3-3η can be detected in all forms of JIA tested but appears to be most common in PJIA RF+. 14-3-3η does not appear to correlate with disease activity in JIA.
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Affiliation(s)
- Iris Reyhan
- University of Southern California-Children's Hospital of Los Angeles, 4650 Sunset Blvd. Mailstop #60, Los Angeles, CA, 90027, USA.
| | | | | | | | | | | | | | - Andreas Reiff
- grid.239546.f0000 0001 2153 6013University of Southern California-Children’s Hospital of Los Angeles, 4650 Sunset Blvd. Mailstop #60, Los Angeles, CA 90027 USA
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10
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Affiliation(s)
- Jong Gyun Ahn
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
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Busch M, Wefelmeyer KL, Walscheid K, Rothaus K, Bauer D, Deeg CA, Degroote RL, Ackermann D, König S, Thanos S, Kasper M, Heiligenhaus A. Identification of Ocular Autoantigens Associated With Juvenile Idiopathic Arthritis-Associated Uveitis. Front Immunol 2019; 10:1793. [PMID: 31447836 PMCID: PMC6691058 DOI: 10.3389/fimmu.2019.01793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/16/2019] [Indexed: 12/28/2022] Open
Abstract
The purpose of the current study was to analyze the binding patterns of serum autoantibodies from juvenile idiopathic arthritis (JIA) and JIA-associated uveitis (JIAU) patients to proteomes from different ocular tissues and to identify potential ocular autoantigens in JIAU. Proteomes from porcine iris, ciliary body, or retina tissue were isolated, separated using 2D-gel electrophoresis, and transferred to a blotting membrane. The binding pattern of serum antibodies from JIA or JIAU patients or healthy controls to ocular proteins was visualized by using anti-human IgG secondary antibodies and chemiluminescence reaction. Selected protein spots were excised from silver-stained 2D gels and subjected to mass spectrometry. Serum antibodies binding to ocular proteins were detected in all patient groups and healthy controls. Irrespective of the patient groups, serum antibodies bound to 49 different protein spots of the retina proteome, to 53 of the ciliary body proteome, and to 44 of the iris proteome. The relative binding frequency of sera to these iris protein spots was significantly higher in JIAU than in JIA patients or healthy controls. Particularly in JIAU patients, cluster analyses indicated a broad range of serum antibodies directed against ocular antigens, mostly in the iris proteome. Iris proteins frequently bound by serum antibodies in all groups were identified as tubulin beta chain, vimentin, ATP synthase subunit beta, actin, and L-lactate dehydrogenase B chain. Iris proteins exclusively bound by JIAU serum antibodies were heat shock cognate 71 kDa protein and keratin. Although serum autoantibody binding to ocular antigens was not disease-specific, a significant diversity of autoantibodies against a broad range of antigens, particularly from the iris tissue, was detected in JIAU patients. As the iris is a major site of inflammation in JIAU, the present data give further evidence that autoantibodies may be involved in JIAU immunopathology.
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Affiliation(s)
- Martin Busch
- Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany
| | - Kira Leona Wefelmeyer
- Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany
| | - Karoline Walscheid
- Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany
| | - Kai Rothaus
- Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany
| | - Dirk Bauer
- Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany
| | - Cornelia A Deeg
- Chair of Animal Physiology, Department of Veterinary Sciences, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Roxane L Degroote
- Chair of Animal Physiology, Department of Veterinary Sciences, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Doreen Ackermann
- IZKF Core Unit Proteomics, University of Münster, Münster, Germany
| | - Simone König
- IZKF Core Unit Proteomics, University of Münster, Münster, Germany
| | - Solon Thanos
- Institute of Experimental Ophthalmology, University of Münster, Münster, Germany
| | - Maren Kasper
- Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany
| | - Arnd Heiligenhaus
- Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany.,Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany.,University of Duisburg-Essen, Essen, Germany
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Patwardhan A. The Utility and Experience with Disease Biomarkers in Juvenile Onset Arthritis vs. Adult Onset Arthritis. Cureus 2019; 11:e5131. [PMID: 31341750 PMCID: PMC6649876 DOI: 10.7759/cureus.5131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common but extremely heterogeneous group of rheumatic diseases of childhood. There are no reliable, well-researched and published biomarkers for diagnosis or monitoring in juvenile idiopathic arthritis as there are for rheumatoid arthritis (RA) in adults. Biomarkers are not utilized in classifying JIA as they are in adult RA, making the JIA classifications less clinically effective and informative. The situation presents a lost opportunity for early aggressive therapy in JIA patients. Various researchers have used diverse biomarkers anecdotally in JIA and more systematically in RA patients and have drawn inferences on their utility from their experiences. The experience with biomarkers from RA patients cannot necessarily be extrapolated for JIA patients because they are dissimilar diseases. This article reconnoiters the comparative utility of various arthritis biomarkers in adult as well as in JIA patients. In contrast to RA, JIA is in itself a diverse group of arthritis with clinically overlapping subgroups with diverse etiology. The difference in the etiopathogenesis of arthritis subgroups demands identifying subgroup-specific biomarkers for diagnosis/monitoring and subgroup-specific therapies for management. The diagnostic/prognostic value of the individual biomarker could be different in different types of arthritis and in different types of hosts. Understanding the utility of individual biomarkers and careful selection of the assay are important to achieve the best disease outcomes.
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Mahmud SA, Binstadt BA. Autoantibodies in the Pathogenesis, Diagnosis, and Prognosis of Juvenile Idiopathic Arthritis. Front Immunol 2019; 9:3168. [PMID: 30693002 PMCID: PMC6339949 DOI: 10.3389/fimmu.2018.03168] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/24/2018] [Indexed: 12/26/2022] Open
Abstract
Autoantibody production occurs in juvenile idiopathic arthritis (JIA) and numerous other autoimmune diseases. In some conditions, the autoantibodies are clearly pathogenic, whereas in others the roles are less defined. Here we review various autoantibodies associated with JIA, with a particular focus on antinuclear antibodies and antibodies recognizing citrullinated self-antigens. We explore potential mechanisms that lead to the development of autoantibodies and the use of autoantibody testing in diagnosis and prognosis. Finally, we compare and contrast JIA-associated autoantibodies with those found in adults with rheumatoid arthritis (RA).
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Affiliation(s)
- Shawn A Mahmud
- Division of Pediatric Rheumatology, Department of Pediatrics, and the Center for Immunology, University of Minnesota, Minneapolis, MN, United States
| | - Bryce A Binstadt
- Division of Pediatric Rheumatology, Department of Pediatrics, and the Center for Immunology, University of Minnesota, Minneapolis, MN, United States
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Shabana K, Okamoto N, Sugita Y, Shindo K, Murata T, Tamai H, Fujiwara K. The findings of musculoskeletal ultrasonography on primary Sjögren's syndrome patients in childhood with articular manifestations and the impact of anti-cyclic citrullinated peptide antibody. Mod Rheumatol 2018; 29:821-828. [PMID: 30289018 DOI: 10.1080/14397595.2018.1530849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: We researched the findings of musculoskeletal ultrasound sonography (MSUS) on primary Sjogren's syndrome in childhood (pSS-C) with articular manifestations. The correlation of rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) were investigated to evaluate the usefulness of MSUS on their articular prognosis. Method: The objective patients are pSS-C cases who visited our hospital complaining joint pain and/or joint swelling and for whom MSUS was performed. Result: Eight patients included 6 female and 2 male, 5 RF-positive patients and 3 ACPA- positive patients. The mean age of onset was 11.1 ± 3.0 years (352 physical joint findings and 284 MSUS findings. The number of joints found clinical articular manifestations was 58/352 joints, and arthritis detected by MSUS was 30/284 joints). In multivariate analysis, the odds ratio of clinical articular manifestations was significant high in RF-positivity (2.9, 95%CI 1.5-6.2). The odds ratio of arthritis detected by MSUS in ACPA-positivity was significant high (3.7, 95%CI 1.5-11.6), although odds ratio in RF-positivity had no statistical significance and a similar trend was seen in odds ratios of subclinical arthritis (4.9, 95%CI 1.6-18.0). Conclusion: It was indicated that MSUS is useful for pSS-C. ACPA-positive pSS-C patients have arthritis and subclinical arthritis more frequently than ACPA-negative patients.
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Affiliation(s)
- Kosuke Shabana
- Departments of Pediatrics, Osaka Medical College , Osaka , Japan
| | - Nami Okamoto
- Departments of Pediatrics, Osaka Medical College , Osaka , Japan
| | - Yuko Sugita
- Departments of Pediatrics, Osaka Medical College , Osaka , Japan
| | - Keisuke Shindo
- Departments of Pediatrics, Osaka Medical College , Osaka , Japan
| | - Takuji Murata
- Departments of Pediatrics, Osaka Medical College , Osaka , Japan
| | - Hiroshi Tamai
- Departments of Pediatrics, Osaka Medical College , Osaka , Japan
| | - Kenta Fujiwara
- Departments of Orthopedics, Osaka Medical College , Osaka , Japan
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Abstract
Juvenile idiopathic arthritis (JIA) comprises a group of heterogeneous diseases further divided into various categories based on shared clinical presentation, laboratory markers, and disease prognosis. Extra-articular complications include uveitis and growth abnormalities. Disease course and prognosis vary with respect to each JIA category and subsequently guide respective treatment. Over the past few decades, considerable treatment advances have significantly reduced the morbidity associated with childhood arthritis. Nevertheless, the treatments are not curative; many children continue to have active disease into adulthood. Emphasis is placed on the initiation of early aggressive therapy in hopes of delaying disease progression and inducing remission.
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Affiliation(s)
- Courtney B Crayne
- Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, 1600 7th Avenue South, CPPN G10, Birmingham, AL 35233, USA
| | - Timothy Beukelman
- Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, 1600 7th Avenue South, CPPN G10, Birmingham, AL 35233, USA.
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17
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Hinks A, Marion MC, Cobb J, Comeau ME, Sudman M, Ainsworth HC, Bowes J, Becker ML, Bohnsack JF, Haas JP, Lovell DJ, Mellins ED, Nelson JL, Nordal E, Punaro M, Reed AM, Rose CD, Rosenberg AM, Rygg M, Smith SL, Stevens AM, Videm V, Wallace CA, Wedderburn LR, Yarwood A, Yeung RSM, Langefeld CD, Thompson SD, Thomson W, Prahalad S. Brief Report: The Genetic Profile of Rheumatoid Factor-Positive Polyarticular Juvenile Idiopathic Arthritis Resembles That of Adult Rheumatoid Arthritis. Arthritis Rheumatol 2018; 70:957-962. [PMID: 29426059 PMCID: PMC5984672 DOI: 10.1002/art.40443] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 02/01/2018] [Indexed: 02/03/2023]
Abstract
Objective Juvenile idiopathic arthritis (JIA) comprises 7 heterogeneous categories of chronic childhood arthritides. Approximately 5% of children with JIA have rheumatoid factor (RF)–positive arthritis, which phenotypically resembles adult rheumatoid arthritis (RA). Our objective was to compare and contrast the genetics of RF‐positive polyarticular JIA with those of RA and selected other JIA categories, to more fully understand the pathophysiologic relationships of inflammatory arthropathies. Methods Patients with RF‐positive polyarticular JIA (n = 340) and controls (n = 14,412) were genotyped using the Immunochip array. Single‐nucleotide polymorphisms were tested for association using a logistic regression model adjusting for admixture proportions. We calculated weighted genetic risk scores (wGRS) of reported RA and JIA risk loci, and we compared the ability of these wGRS to predict RF‐positive polyarticular JIA. Results As expected, the HLA region was strongly associated with RF‐positive polyarticular JIA (P = 5.51 × 10−31). Nineteen of 44 RA risk loci and 6 of 27 oligoarticular/RF‐negative polyarticular JIA risk loci were associated with RF‐positive polyarticular JIA (P < 0.05). The RA wGRS predicted RF‐positive polyarticular JIA (area under the curve [AUC] 0.71) better than did the oligoarticular/RF‐negative polyarticular JIA wGRS (AUC 0.59). The genetic profile of patients with RF‐positive polyarticular JIA was more similar to that of RA patients with age at onset 16–29 years than to that of RA patients with age at onset ≥70 years. Conclusion RF‐positive polyarticular JIA is genetically more similar to adult RA than to the most common JIA categories and thus appears to be a childhood‐onset presentation of autoantibody‐positive RA. These findings suggest common disease mechanisms, which could lead to novel therapeutic targets and shared treatment strategies.
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Affiliation(s)
- Anne Hinks
- University of Manchester, Manchester, UK
| | - Miranda C Marion
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Joanna Cobb
- University of Manchester and Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Mary E Comeau
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Marc Sudman
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hannah C Ainsworth
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - John Bowes
- University of Manchester, Manchester, UK
| | | | | | | | - Johannes-Peter Haas
- German Centre for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - J Lee Nelson
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle
| | - Ellen Nordal
- University Hospital of North Norway and UIT The Arctic University of Norway, Tromsø, Norway
| | - Marilynn Punaro
- Arthritis Clinic Texas Scottish Rite Hospital for Children and University of Texas Southwestern Medical Center, Dallas
| | - Ann M Reed
- Duke University School of Medicine, Durham, North Carolina
| | | | | | - Marite Rygg
- Norwegian University of Science and Technology and St. Olav's University Hospital, Trondheim, Norway
| | | | - Anne M Stevens
- Seattle Children's Research Institute and University of Washington, Seattle
| | - Vibeke Videm
- Norwegian University of Science and Technology and St. Olav's University Hospital, Trondheim, Norway
| | - Carol A Wallace
- Seattle Children's Hospital and Research Institute, Seattle, Washington
| | - Lucy R Wedderburn
- University College London and NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | | | - Rae S M Yeung
- The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Carl D Langefeld
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | - Wendy Thomson
- University of Manchester and Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Sampath Prahalad
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
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18
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Peckham H, Cambridge G, Bourke L, Sen D, Radziszewska A, Leandro M, Ioannou Y. Antibodies to Cyclic Citrullinated Peptides in Patients With Juvenile Idiopathic Arthritis and Patients With Rheumatoid Arthritis: Shared Expression of the Inherently Autoreactive 9G4 Idiotype. Arthritis Rheumatol 2017; 69:1387-1395. [PMID: 28380667 DOI: 10.1002/art.40117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/30/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Antibodies to cyclic citrullinated peptides (anti-CCP) in rheumatoid arthritis (RA) can express the inherently autoreactive gene VH 4-34, detected using the rat monoclonal antibody 9G4. Patients with the polyarticular subtype of juvenile idiopathic arthritis (JIA) share some but not all of the features of adult patients with RA. This study was undertaken to compare serologic findings for rheumatoid factor (RF), anti-CCP, and 9G4-expressing anti-CCP in a large JIA cohort with a cohort of adult RA patients. METHODS Serum from 88 patients with polyarticular JIA, 29 patients with enthesitis-related arthritis, 38 patients with extended oligoarthritis, 31 adolescent controls, 35 patients with RA, and 30 adult controls were tested for RF, for IgG, IgA, and IgM anti-CCP, and for 9G4-expressing anti-CCP by enzyme-linked immunosorbent assay. Total serum 9G4-positive IgM was also measured. RESULTS Of 65 patients with RF-negative polyarticular JIA, 4 (6.2%) were IgG anti-CCP positive. Sera from 20 of 23 patients with RF-positive polyarticular JIA (87.0%), 24 of 35 patients with RA (68.6%), and 1 patient with extended oligoarthritis contained IgG anti-CCP. IgA and IgM anti-CCP levels were lower in the adolescent group (P < 0.01). Levels of 9G4-expressing anti-CCP were higher in patients with RF-positive polyarticular JIA than in those with RF-negative polyarticular JIA (P < 0.0001). Median levels of 9G4-expressing anti-CCP in patients with RF-positive polyarticular JIA and those with RA did not differ. Expression of 9G4 on serum total IgM was greater in patients with RF-positive polyarticular JIA than other adolescent groups (P < 0.01), but similar to adult RF-positive RA. CONCLUSION In healthy individuals, 9G4-positive B cells comprise 5-10% of the peripheral blood pool but serum immunoglobulins utilizing VH 4-34 are disproportionately low. The idiotope recognized by 9G4 was detected on anti-CCP antibodies in >80% of patients with RF-positive polyarticular JIA. VH 4-34 usage by anti-CCP in both JIA and RA patients suggest elicitation of these autoantibodies through shared pathogenic B cell selection processes.
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Affiliation(s)
- Hannah Peckham
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | | | - Lauren Bourke
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Debajit Sen
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Anna Radziszewska
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | | | - Yiannis Ioannou
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
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19
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Akioka S. A better understanding of juvenile idiopathic arthritis with classification criteria. NIHON RINSHO MEN'EKI GAKKAI KAISHI = JAPANESE JOURNAL OF CLINICAL IMMUNOLOGY 2017; 39:513-521. [PMID: 28049960 DOI: 10.2177/jsci.39.513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Juvenile idiopathic arthritis, JIA, is a novel rheumatic disease in childhood introduced by the International League of Associations for Rheumatology. It is defined as a chronic, inflammatory disorder of unknown etiology, which is classified into seven categories; systemic-onset type, persistent and extended oligoarthritis, polyarthritis with rheumatoid factor negative, polyarthritis with rheumatoid factor positive, psoriatic arthritis, enthesitis-related arthritis and undifferentiated arthritis. As each category of JIA has different features in clinical phenotypes, precise subtyping is required for research and management. However, some modifications to the criteria might be helpful for getting better answers in diagnosis because of ethnical difference in prevalence and subtype distribution. Actually in Japanese population, a unique subset "B27-negative polyenthesitis" termed by Shichikawa should be included in enthesitis-related arthritis of JIA as a different type of enthesitis from B27-positive counterpart of spondyloarthritis in adulthood. Deep insights into the classification criteria will be needed for the better understanding of JIA.
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Affiliation(s)
- Shinji Akioka
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
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20
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Anti-MCV and anti-CCP antibodies—diagnostic and prognostic value in children with juvenile idiopathic arthritis (JIA). Clin Rheumatol 2016; 35:2699-2706. [DOI: 10.1007/s10067-016-3355-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 07/09/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
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21
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Rationale Diagnostik der juvenilen idiopathischen Arthritis. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-014-3279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Evaluation of anti-cyclic citrullinated peptide antibodies may be beneficial in RF-negative juvenile idiopathic arthritis patients. Clin Rheumatol 2015; 35:601-7. [PMID: 25994613 DOI: 10.1007/s10067-015-2971-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 03/30/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
Despite the high diagnostic and prognostic performance in adult rheumatoid arthritis, the role of antibodies to cyclic citrullinated peptide (anti-CCP) in juvenile idiopathic arthritis (JIA) is controversial. Occurrence of anti-CCP was mainly seen in rheumatoid factor (RF)-positive polyarthritis patients. In the present study, our aim was to investigate the prevalence and significance of anti-CCP for subjects with JIA in our population. We evaluated anti-CCP reactivity in the sera of 70 patients with various subtypes of JIA in a prospective cohort study. Anti-CCP titres were correlated with the evolution of joint involvement and the presence of joint damage. Nine JIA patients were seropositive for anti-CCP with respect to the cut-off value of the test. In our cohort, 34 patients had a polyarticular joint disease, most of them being RF-negative (30/34, 88 %). All four RF-positive polyarthritis patients had high anti-CCP concentrations and an aggressive erosive disease. In the RF-negative JIA patients, anti-CCP reactivity was in lower titres but significantly associated with polyarticular joint involvement (p = 0.016) and also with the presence of joint damage (p < 0.001). Presence of anti-CCP, at both low and high concentration, was significantly associated with a more severe articular disease in our JIA patients. Investigating anti-CCP should clearly be taken into consideration even among patients with JIA subtypes other than RF-positive polyarthritis.
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23
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Tozawa Y, Fujita S, Abe S, Kitamura K, Kobayashi I. Radiological improvement by tocilizumab in polyarticular juvenile idiopathic arthritis. Pediatr Int 2015; 57:307-10. [PMID: 25868948 DOI: 10.1111/ped.12454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/08/2014] [Accepted: 07/11/2014] [Indexed: 11/29/2022]
Abstract
Recent advances in biologic therapy have enabled reduction of the progression of destructive arthritis in rheumatoid arthritis. Once destroyed, however, the affected bones and cartilage are not fully repaired. We describe the case of an 8-year-old girl with anti-citrullinated peptide antibody (ACPA)-positive polyarticular juvenile idiopathic arthritis (p-JIA). Destructive arthritis progressed during combination therapy with infliximab, methotrexate, mizoribine and prednisolone. Clinical remission was achieved, however, after switching the biologic agent to tocilizumab, a humanized monoclonal antibody to interleukin-6 receptor. Both bone erosion and bone marrow edema on magnetic resonance imaging were repaired in association with restoration of joint spaces. Furthermore, there was no relapse of arthritis on weekly methotrexate alone for 2 years after discontinuation of the tocilizumab. Tocilizumab led to radiological repair of both bone and cartilage destruction and long-term biologics-free remission in a patient with ACPA-positive p-JIA, and should be considered for tumor necrosis factor inhibitor-resistant cases.
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Affiliation(s)
- Yusuke Tozawa
- Department of Pediatrics, Goryokaku Hospital, Hakodate
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24
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Wang Y, Pei F, Wang X, Sun Z, Hu C, Dou H. Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody for juvenile idiopathic arthritis. J Immunol Res 2015; 2015:915276. [PMID: 25789331 PMCID: PMC4350619 DOI: 10.1155/2015/915276] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/01/2015] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To estimate the diagnostic accuracy of the anti-CCP test in JIA and to evaluate factors associated with higher accuracy. METHODS Two investigators performed an extensive search of the literature published between January 2000 and January 2014. The included articles were assessed by the Quality Assessment of Diagnostic Accuracy Studies tool. The meta-analysis was performed using a summary ROC (SROC) curve and a bivariate random-effect model to estimate sensitivity and specificity across studies. RESULTS The bivariate meta-analysis yielded a pooled sensitivity and specificity of 10% (95% confidence interval (CI): 6.0%-15.0%) and 99.0% (95% CI: 98.0%-100.0%). The area under the SROC curve was 0.96. Sensitivity estimates were highly heterogeneous, which was partially explained by the higher sensitivity in the rheumatoid factor-positive polyarthritis (RF+ PA) subtype (48.0%; 95% CI: 31.0%-65.0%) than in the other subtypes (17.0%; 95% CI: 14.0%-20.0%) and the higher sensitivity of the Inova assay (17.0%; 95% CI: 14.0%-20.%%) than the other assays (0.05%; 95% CI: 2.0%-11.0%). CONCLUSIONS Anti-CCP antibody test has a high specificity for the diagnosis of JIA. The sensitivity of this test is low and varies across populations but is higher in RF+ PA than in other JIA subtypes.
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Affiliation(s)
- Yan Wang
- Department of Laboratory Medicine, General Hospital of Jinan Military Area, Jinan, Shandong 250031, China
| | - Fengyan Pei
- Department of Laboratory Medicine, Jinan Central Hospital, Jinan, Shandong 250013, China
| | - Xingjuan Wang
- Department of Laboratory Medicine, General Hospital of Jinan Military Area, Jinan, Shandong 250031, China
| | - Zhiyu Sun
- Department of Laboratory Medicine, General Hospital of Jinan Military Area, Jinan, Shandong 250031, China
| | - Chengjin Hu
- Department of Laboratory Medicine, General Hospital of Jinan Military Area, Jinan, Shandong 250031, China
| | - Hengli Dou
- Division of Chest Disease, The Fourth Hospital of Jinan, Jinan, Shandong 250031, China
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25
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Webb T, Lakos G, Swart A, Gürtler I, Favalli EG, Schioppo T, Mahler M. Clinical evaluation of a novel chemiluminescent immunoassay for the detection of anti-citrullinated peptide antibodies. Clin Chim Acta 2014; 437:161-7. [DOI: 10.1016/j.cca.2014.07.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 07/23/2014] [Accepted: 07/23/2014] [Indexed: 11/29/2022]
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Oberle EJ, Harris JG, Verbsky JW. Polyarticular juvenile idiopathic arthritis - epidemiology and management approaches. Clin Epidemiol 2014; 6:379-93. [PMID: 25368531 PMCID: PMC4216020 DOI: 10.2147/clep.s53168] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is a group of disorders characterized by arthritis persisting for at least 6 weeks with onset before the age of 16 years. Within this cluster of conditions, the polyarticular form (involving more than four joints within the first 6 months) is further divided based on the presence of rheumatoid factor. Children with polyarticular JIA pose unique diagnostic and therapeutic challenges compared to children with involvement of fewer joints. Polyarticular JIA patients tend to have a more refractory course and therefore are at increased risk for joint damage, resulting in poorer functional outcomes and decreased quality of life. Although the ability to treat this disorder continues to improve, especially with the advent of biologic agents, there is still much about the epidemiology and pathogenesis of polyarticular JIA that is unknown. The epidemiology of polyarticular JIA varies worldwide with a vast difference in reported cases between different global regions as well as within individual countries. Several genetic risk loci have been identified conferring increased susceptibility to JIA, many within the human leukocyte antigen region. Beyond the genome, environmental factors also seem to contribute to the etiology of polyarticular JIA. This review article will focus on the epidemiology and current treatments of polyarticular JIA and briefly discuss genetic and environmental influences on the pathogenesis of JIA as well as new and emerging therapies.
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Affiliation(s)
- Edward J Oberle
- Department of Pediatrics, Division of Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Julia G Harris
- Department of Pediatrics, Division of Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James W Verbsky
- Department of Pediatrics, Division of Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
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27
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Payet J, Goulvestre C, Bialé L, Avouac J, Wipff J, Job-Deslandre C, Batteux F, Dougados M, Kahan A, Allanore Y. Anticyclic Citrullinated Peptide Antibodies in Rheumatoid and Nonrheumatoid Rheumatic Disorders: Experience with 1162 Patients. J Rheumatol 2014; 41:2395-402. [DOI: 10.3899/jrheum.131375] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective.Anticyclic citrullinated peptide antibodies (anti-CCP) are considered specific markers of rheumatoid arthritis (RA) and have been included in the revised classification criteria for RA diagnosis. However, these antibodies have also been detected in patients with other types of chronic inflammatory rheumatism. Our objectives were to identify the prevalence of positive anti-CCP patients in non-RA diseases, to determine the diagnostic value of anti-CCP for the diagnosis of RA, to specify the clinical characteristics of non-RA patients positive for anti-CCP, and to determine the discriminatory value of the levels of anti-CCP in patients among the various diseases.Methods.We carried out an observational and descriptive study. All the determinations of anti-CCP requested by the 2 rheumatology departments at Cochin Hospital over a period of 18 months were analyzed. Such determinations were requested for 1162 patients in total. Anti-CCP levels were determined with the Euro Diagnostica ELISA kit, with values ≥ 25 U for this test being considered positive. The diagnosis of rheumatic conditions was the responsibility of the treating physician.Results.Anti-CCP antibodies were detected in 357 (30.7%) of the 1162 patients. The prevalence of anti-CCP was 292/417 (70.0%) in RA, 13/122 (10.6%) in patients with psoriatic arthritis, 13/62 (20.9%) in patients with unclassified rheumatism, 11/33 (33.3%) in patients with primary Sjögren syndrome, 5/30 (16.6%) in patients with systemic lupus erythematosus, 3/28 (10.7%) in patients with mixed connective tissue disorder, 3/36 (8.3%) in patients with systemic sclerosis, 7/44 (15.9%) in patients with juvenile arthritis, and 6/220 (2.7%) in patients with noninflammatory diseases. In the population of patients positive for anti-CCP, mean anti-CCP levels were 869.4 (± 978.4) U/ml, with no significant difference between RA [854.8 (± 959.8) U/ml] and any of the non-RA conditions [922.7 (± 1070.0) U/ml].Conclusion.Anti-CCP are a hallmark of RA, but may be observed in other inflammatory, systemic, or mechanical diseases. In this large cohort of patients, the presence of second-generation anti-CCP (anti-CCP2) antibodies is useful in diagnosing RA (70% sensitivity, 91.3% specificity), but examining the levels of these antibodies does not appear to offer further discriminatory power among patients who are anti-CCP2-positive.
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28
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Abstract
BACKGROUND Many aspects of autoimmune disease are not well understood, including the specificities of autoimmune targets, and patterns of co-morbidity and cross-heritability across diseases. Prior work has provided evidence that somatic mutation caused by gene conversion and deletion at segmentally duplicated loci is relevant to several diseases. Simple tandem repeat (STR) sequence is highly mutable, both somatically and in the germ-line, and somatic STR mutations are observed under inflammation. RESULTS Protein-coding genes spanning STRs having markers of mutability, including germ-line variability, high total length, repeat count and/or repeat similarity, are evaluated in the context of autoimmunity. For the initiation of autoimmune disease, antigens whose autoantibodies are the first observed in a disease, termed primary autoantigens, are informative. Three primary autoantigens, thyroid peroxidase (TPO), phogrin (PTPRN2) and filaggrin (FLG), include STRs that are among the eleven longest STRs spanned by protein-coding genes. This association of primary autoantigens with long STR sequence is highly significant (p<3.0x10(-7)). Long STRs occur within twenty genes that are associated with sixteen common autoimmune diseases and atherosclerosis. The repeat within the TTC34 gene is an outlier in terms of length and a link with systemic lupus erythematosus is proposed. CONCLUSIONS The results support the hypothesis that many autoimmune diseases are triggered by immune responses to proteins whose DNA sequence mutates somatically in a coherent, consistent fashion. Other autoimmune diseases may be caused by coherent somatic mutations in immune cells. The coherent somatic mutation hypothesis has the potential to be a comprehensive explanation for the initiation of many autoimmune diseases.
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Affiliation(s)
- Kenneth Andrew Ross
- Department of Computer Science, Columbia University, New York, New York, United States of America
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29
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Berntson L, Nordal E, Fasth A, Aalto K, Herlin T, Nielsen S, Rygg M, Zak M, Rönnelid J. Anti-type II collagen antibodies, anti-CCP, IgA RF and IgM RF are associated with joint damage, assessed eight years after onset of juvenile idiopathic arthritis (JIA). Pediatr Rheumatol Online J 2014; 12:22. [PMID: 24944545 PMCID: PMC4061516 DOI: 10.1186/1546-0096-12-22] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 06/06/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Early appearance of antibodies specific for native human type II collagen (anti-CII) characterizes an early inflammatory and destructive phenotype in adults with rheumatoid arthritis (RA). The objective of this study was to investigate the occurrence of anti-CII, IgM RF, IgA RF and anti-CCP in serum samples obtained early after diagnosis, and to relate the occurrence of autoantibodies to outcome after eight years of disease in children with juvenile idiopathic arthritis (JIA). METHODS The Nordic JIA database prospectively included JIA patients followed for eight years with data on remission and joint damage. From this database, serum samples collected from 192 patients, at a median of four months after disease onset, were analysed for IgG anti-CII, IgM RF, IgA RF and IgG anti-CCP. Joint damage was assessed based on Juvenile Arthritis Damage Index for Articular damage (JADI-A), a validated clinical instrument for joint damage. RESULTS Elevated serum levels of anti-CII occurred in 3.1%, IgM RF in 3.6%, IgA RF in 3.1% and anti-CCP in 2.6% of the patients. Occurrence of RF and anti-CCP did to some extent overlap, but rarely with anti-CII. The polyarticular and oligoarticular extended categories were overrepresented in patients with two or more autoantibodies. Anti-CII occurred in younger children, usually without overlap with the other autoantibodies and was associated with high levels of C-reactive protein (CRP) early in the disease course. All four autoantibodies were significantly associated with joint damage, but not with active disease at the eight-year follow up. CONCLUSIONS Anti-CII, anti-CCP, IgA RF and IgM RF detected early in the disease course predicted joint damage when assessed after eight years of disease. The role of anti-CII in JIA should be further studied.
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Affiliation(s)
- Lillemor Berntson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Ellen Nordal
- Department of Pediatrics, University Hospital of North Norway, Tromsø, Norway,Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Anders Fasth
- Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden
| | - Kristiina Aalto
- Department of Pediatrics, Children’s Hospital, Helsinki University Hospital, Helsinki, Finland
| | | | - Susan Nielsen
- University Clinic of Pediatrics II, Rigshospitalet, Copenhagen, Denmark
| | - Marite Rygg
- Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, Trondheim, Norway,Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
| | - Marek Zak
- University Clinic of Pediatrics II, Rigshospitalet, Copenhagen, Denmark
| | - Johan Rönnelid
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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30
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Ferrell EG, Ponder LA, Minor LS, Angeles-Han ST, Kennedy CW, Rouster-Stevens KA, Rohani-Pichavant M, Vogler LB, Prahalad S. Limitations in the classification of childhood-onset rheumatoid arthritis. J Rheumatol 2014; 41:547-53. [PMID: 24488421 DOI: 10.3899/jrheum.130563] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Rheumatoid factor-positive polyarthritis (RF+ poly) is the juvenile idiopathic arthritis (JIA) category that resembles adult seropositive rheumatoid arthritis (RA). We studied children with RF+ and/or anticyclic citrullinated peptide antibody (anti-CCP)+ JIA to determine what proportion of those children meet International League of Associations for Rheumatology (ILAR) criteria for RF+ poly JIA and to assess for significant differences between children who meet RF+ poly criteria and those who are classified in other categories. METHODS Charts of children with JIA who were RF+ and/or anti-CCP+ were reviewed. Children with RF+ poly JIA were compared to children in other categories. Statistical analysis was performed using chi-square, Fisher's exact test, and the Student's t-test. RESULTS Of 56 children with RF+ and/or anti-CCP+ JIA, 34 (61%) met ILAR criteria for RF+ poly JIA. Twelve children had RF-/anti-CCP+ JIA with low anti-CCP titers. When these 12 children were excluded, there were few significant differences between children who met criteria for RF+ poly and those who were classified in other categories. The American College of Rheumatology/European League Against Rheumatism criteria for RA identified more RF+ children than did the ILAR RF+ poly classification (100% vs 77%). CONCLUSION A number of children with RF+ arthritis were excluded from the RF+ poly JIA classification, though many demographic features and disease measures were similar to those of children who met criteria for RF+ poly JIA. We propose prioritization of RF/anti-CCP positivity over specific exclusions, along with inclusion of anti-CCP, in future revisions of the JIA classification criteria, to improve the sensitivity of diagnosing childhood-onset RA.
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Affiliation(s)
- Emily G Ferrell
- From the Department of Pediatrics, and the Department of Human Genetics, Emory University School of Medicine; Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Kourilovitch M, Galarza-Maldonado C, Ortiz-Prado E. Diagnosis and classification of rheumatoid arthritis. J Autoimmun 2014; 48-49:26-30. [DOI: 10.1016/j.jaut.2014.01.027] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/13/2013] [Indexed: 10/25/2022]
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Kang M, Sohn TY, Kim SH, Lee HR, Kang HJ, Kim KN. The Clinical Significance of Anti-cyclic Citrullinated Peptide Antibodies in Juvenile Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2014. [DOI: 10.4078/jrd.2014.21.5.236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Min Kang
- Department of Pediatric and Adolescent Medicine, College of Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Tae-Young Sohn
- Department of Pediatric and Adolescent Medicine, College of Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sung-Hye Kim
- Department of Pediatric and Adolescent Medicine, College of Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hae-Ran Lee
- Department of Pediatric and Adolescent Medicine, College of Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hee-Jung Kang
- Department of Pediatric and Adolescent Medicine, College of Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang-Nam Kim
- Department of Pediatric and Adolescent Medicine, College of Hallym University Sacred Heart Hospital, Anyang, Korea
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Stoll ML, Cron RQ. Treatment of Juvenile Idiopathic Arthritis in the Biologic Age. Rheum Dis Clin North Am 2013; 39:751-66. [DOI: 10.1016/j.rdc.2013.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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