Significance of Anti-cyclic Citrullinated Peptide Autoantibodies in Immune-mediated Inflammatory Skin Disorders with and without Arthritis

Assessment of serum levels of anti-cyclic citrullinated peptide antibodies in patients with psoriatic arthritis: A cross-sectional study in a Brazilian cohort

Presence of the anti-cyclic citrullinated peptide (CCP) antibody is considered a hallmark of rheumatoid arthritis, and may be found in patients with other rheumatic diseases, including psoriatic arthritis (PsA). The aim of the present study was to determine whether the anti-CCP antibody was present in patients with psoriasis with and without arthritis. and to determine whether its presence was associated with clinical, serological and treatment data in patients with PsA. The present study was a cross-sectional study, which included 91 patients with psoriasis (41 with arthritis and 48 without arthritis) as well as an age and sex matched control group consisting of 100 healthy individuals. Presence of the anti-CCP antibody was determined using commercially available ELISA kits. Data on clinical, serological and treatment characteristics was obtained from reviewing each patient's medical history. The quality of life and articular inflammatory activity were assessed using the Short Form Health Survey-12 questionnaire. Skin disease was evaluated using the Psoriasis Area Severity Index and body surface area. In the control group, 1% of individuals were positive for the anti-CCP antibody, whereas 17.5% of the psoriasis patients were positive (P<0.001). In the patients with PsA, 20.9% were positive for the antibody, and in patients with psoriasis without joint disease, 14.5% were positive (P=0.58). Patients with polyarticular forms of PsA were more likely to be anti-CCP positive compared with patients with skin disease without arthritis (P=0.009). In the group of patients with PsA, those who were anti-CCP positive were more likely to suffer from polyarticular forms of arthritis, but no differences were found in the quality of life, joint disease activity, degree of skin involvement and treatment requirements (all P>0.05). In conclusion, 17.5% of patients with psoriasis and 20.9% of patients with PsA were positive for anti-CCP antibodies. Polyarticular arthritis was more common in the anti-CCP positive patients compared with the anti-CCP negative patients.

Evaluation of Anti-Cyclic Citrullinated Peptide Autoantibodies and C-Reactive Protein in Common Autoimmune Skin Diseases with and without Arthritis

INTRODUCTION

Anti-Cyclic Citrullinated Peptides (CCPs) are a well known diagnostic and prognostic noble marker for rheumatoid arthritis. C-Reactive Protein (CRP) is an acute phase protein whose level rises in response to inflammation.

AIM

This study was undertaken to show the role of the two markers (anti-CCPs and CRP) in autoimmune skin disorder and their association with associated arthritis in these disorder.

MATERIALS AND METHODS

Serum anti-CCP antibodies and CRP was measured in 50 patients of autoimmune skin disease of which 28 were of psoriasis, 12 of Systemic Lupus Erythematosus (SLE) and 10 of Pemphigus Vulgaris (PV). These patients were categorised in two groups, with associated arthritis and without arthritis. The serum level of anti-CCP and CRP was correlated with the presence or absence of arthritis in these patients. Control group consists of 20 healthy subjects in which these two parameters were measured.

RESULTS

Out of total of 50 patients, anti-CCP was raised in 36.37% of patients with associated arthritis and 12.82% of patients without arthritis whereas CRP was raised in 63.63% of patients with arthritis and 35.89% of patients without arthritis. Mean serum anti-CCP in patient with arthritis was 15.78±13.94 U/ml and without arthritis was 7.56±7.68 U/ml with p=0.01 which was statistically significant. Mean serum CRP in arthritis was 21.11±15.51 mg/l and CRP without arthritis was 13.14±12.27 mg/l with p=0.07 which was statistically not significant.

CONCLUSION

Although both anti-CCP and CRP are valuable markers for autoimmune skin disorder, anti-CCP seems to show significant association with arthritis.

Psoriasis in systemic lupus erythematosus: a single-center experience

The coexistence of psoriasis with systemic lupus erythematosus (SLE) has been reported in limited case series, raising hypotheses about shared pathogenetic mechanisms. Nevertheless, important differences regarding treatment do exist. The aim of the present study was to determine the prevalence and characteristics of psoriasis in a defined cohort of lupus patients. Patients with psoriasis were retrieved from the University of Toronto Lupus Clinic from its inception in 1970 up to 2015. Charts were hand-searched to collect information concerning demographic, clinical, and therapeutic variables. Patients were matched with non-psoriasis lupus patients to identify the impact of supervening psoriasis on lupus activity, damage accrual, and venous thromboembolic (VTEs) and cardiovascular events (CVEs). Psoriasis was diagnosed in 63 patients (49 females, 14 males) for a prevalence of 3.46% (63/1823). The male-to-female ratio was significantly higher in non-psoriasis patients (0.286 vs. 0.138, p = 0.017). Plaque psoriasis was the most prominent type (55/63, 87.3%) whereas three patients had pustular disease; one had psoriatic arthritis. Nine patients (14.3%) were administered systemic treatment with methotrexate (n = 5), azathioprine (n = 1), ustekinumab (n = 3), and etanercept (n = 1). Psoriasis was definitely deteriorated by hydroxychloroquine in one patient. There was no significant impact of psoriasis on disease activity, damage accrual, VTEs, and CVEs. The prevalence of psoriasis was twice as high as that of the general Canadian population in this lupus cohort. Plaque psoriasis was the most prominent subtype, and topical treatment was adequate in the majority of patients. Supervening psoriasis had no significant impact on lupus activity and damage accrual.