The ACPA recognition profile and subgrouping of ACPA-positive RA patients.

Abstract:

OBJECTIVE:Anticitrullinated protein antibodies (ACPA) are the most predictive factor for the development of rheumatoid arthritis (RA). Epitope spreading towards more citrullinated epitopes occurs before the onset of RA. Here, the authors investigated whether specific epitope recognition allows the identification of specific RA subgroups and whether it is associated with clinical features of RA. METHODS:The reactivity of 661 patients with RA from the Leiden Early Arthritis Clinic against several citrullinated antigens was determined by ELISA. Cluster analyses were performed to identify subgroups of patients on the basis of their ACPA recognition profile. The association of the specific reactivities with clinical characteristics was studied. RESULTS:ACPA-positive patients displayed a heterogeneous ACPA recognition profile. After performing cluster analyses, no apparent clustering of patients was found, and on the basis of the reactivities analysed, 64 different subgroups could already be identified. The extent of epitope recognition was associated with anticyclic citrullinated peptide-2 levels. The recognition of specific citrullinated epitopes was not associated with baseline characteristics. Likewise, patients with an extended fine specificity repertoire did not display differences in baseline characteristics or joint damage after 7 years of follow-up using cyclic citrullinated peptide-2 levels as a proxy, compared to ACPA-positive patients recognising fewer peptides. CONCLUSION:These data show that the ACPA response is highly diverse with respect to recognition of specific citrullinated epitopes. Furthermore, the authors' data indicate that clinical correlates in established ACPA-positive RA are independent from the specific (group of) citrullinated peptides recognised.

journal_name

Ann Rheum Dis

authors

Willemze A,Böhringer S,Knevel R,Levarht EW,Stoeken-Rijsbergen G,Houwing-Duistermaat JJ,van der Helm-van Mil AH,Huizinga TW,Toes RE,Trouw LA

doi

10.1136/annrheumdis-2011-200421

subject

Has Abstract

pub_date

2012-02-01 00:00:00

pages

268-74

issue

2

eissn

0003-4967

issn

1468-2060

pii

annrheumdis-2011-200421

journal_volume

71

pub_type

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