A study of erosive phenotypes in lupus arthritis using magnetic resonance imaging and anti-citrullinated protein antibody, anti-RA33 and RF autoantibody status

Ball, Elisabeth; Tan, Ai Lyn; Fukuba, Eiji; McGonagle, Dennis; Grey, Arthur; Steiner, Günter; Bell, A. L.; Rooney, Madeleine R

doi:10.1093/rheumatology/keu215

Cited by 39 publications

(23 citation statements)

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“…However, only a minority of the patients with SLE who have an arthritic phenotype simultaneously meet RA classification criteria [24, 25, 31]. The presence of anti-CCP antibodies is considered highly specific for RA, but can also be found in other conditions, including SLE, where frequencies from 2–17% have been described [9, 32, 45–51]. Whether or not there is a true association between a positive anti-CCP test and erosive arthritis in SLE remains an open question, as several investigators have reported this [9, 46–50], whereas others have not [31, 45].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…A limited number of studies have evaluated magnetic resonance imaging (MRI) in the assessment of patients with articular involvement in SLE [29–32]. Recently, Ball and colleagues demonstrated that MRI is highly sensitive in identifying erosions, synovitis and bone oedema, independently of anti-CCP and RF antibody status [32]. In SLE, there are some reports based on musculoskeletal ultrasonography (US), but so far this modality has seldom been used in clinical routine practice [31, 33].…”

Section: Introductionmentioning

confidence: 99%

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Antibodies against carbamylated proteins and cyclic citrullinated peptides in systemic lupus erythematosus: results from two well-defined European cohorts

et al. 2016

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BackgroundArticular manifestations are common in systemic lupus erythematosus (SLE) whereas erosive disease is not. Antibodies to cyclic citrullinated peptide (anti-CCP) are citrulline-dependent in rheumatoid arthritis (RA), whereas the opposite is suggested in SLE, as reactivity with cyclic arginine peptide (CAP) is typically present. Antibodies targeting carbamylated proteins (anti-CarP) may occur in anti-CCP/rheumatoid factor (RF)-negative cases long before clinical onset of RA. We analysed these antibody specificities in sera from European patients with SLE in relation to phenotypes, smoking habits and imaging data.MethodsCases of SLE (n = 441) from Linköping, Sweden, and Leiden, the Netherlands, were classified according to American College of Rheumatology (ACR) and/or Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) criteria. IgG anti-CCP, anti-CAP and anti-CarP were analysed by immunoassays. Radiographic data from 102 Swedish patients were available.ResultsThere were 16 Linköping (6.8%) and 11 Leiden patients (5.4%) who were anti-CCP-positive, of whom approximately one third were citrulline-dependent: 40/441 (9.1%) were anti-CarP-positive, and 33% of the anti-CarP-positive patients were identified as anti-CCP-positive. No associations were found comparing anti-CCP or anti-CarP with ACR-defined phenotypes, immunologic abnormalities or smoking habits. Radiographically confirmed erosions were found in 10 patients, and were significantly associated with anti-CCP, anti-CarP and RF. Musculoskeletal ultrasonography scores were higher in anti-CCP-positive compared to anti-CCP-negative patients.ConclusionsIn the hitherto largest anti-CarP study in SLE, we demonstrate that anti-CarP is more prevalent than anti-CCP and that the overlap is limited. We obtained some evidence that both autoantibodies seem to be associated with erosivity. Similar pathogenetic mechanisms to those seen in RA may be relevant in a subgroup of SLE cases with a phenotype dominated by arthritis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Antibodies against carbamylated proteins and cyclic citrullinated peptides in systemic lupus erythematosus: results from two well-defined European cohorts

et al. 2016

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“…In a recent study of Ball et al, it has been reported that MRI was highly sensitive in identifying synovitis, bone edema, and erosive deformities, independent from anti-CCP and RF in SLE patients [32].This finding indicates that arthritis can be present even when anti-CCP and RF levels are not elevated. This finding supports the studies that were unable to show the relationship between anti-CCP and arthritis in patients with SLE.…”

Section: Discussionmentioning

confidence: 88%

Evaluation of clinical and laboratory findings of 147 patients with systemic lupus erythematosus: The relationship between anti-CCP and arthritis

Ekin¹,

Çefle²

2019

Journal of Surgery and Medicine

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How to cite / Atıf için: Ekin A, Çefle AE. Evaluation of clinical and laboratory findings of 147 patients with systemic lupus erythematosus: The relationship between anti-CCP and arthritis.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND 4.0) where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. AbstractAim: Anti-cyclic citrullinated peptide antibodies (Anti-CCP) is considered as a novel marker in the assessment of rheumatoid disorders. Some studies have emphasized the importance of anti-CCP in indicating erosive arthropathy in Systemic Lupus Erythematosus (SLE), like Rheumatoid Arthritis (RA). These studies have reported that the chance of erosive arthritis development is significantly increased in anti-CCP-positive patients. This study aimed to investigate the relationship between anti-CCP and arthritis along with other clinical and laboratory parameters in patients with SLE.Methods: A total of 147 SLE patients who had been admitted to

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“…A recent MRI study showed a high incidence of subclinical hand and wrist arthritis, with erosions not infrequently seen, which may offer an explanation for the high prevalence of arthralgias in SLE patients. [23] Arthritis in SLE should be treated with AMs, shortterm nonsteroidal antiinflammatory drugs, and lowdose (<10 mg) CS. Patients with ongoing arthritis may benefit from MTX.…”

Section: Arthritismentioning

confidence: 99%

Evidence-based treatment of systemic lupus erythematosus and its complications

Hodkinson

Makda

2015

S Afr Med J

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Ideally, all systemic lupus erythematosus (SLE) patients should be reviewed by a specialist. Early referral to a rheu matologist has been associated with faster treatment modification and better outcomes. However, primary care doctors are the first point of care for new SLE patients or those presenting with a new complication. Moreover, given the shortage of rheumatologists in South Africa (SA) and elsewhere in Africa, primary care clinicians and general physicians are often faced with sick SLE patients and are required to make rapid therapeutic decisions. This review summarises current evidence for the treatment of SLE and its complications. We prepared this review after a PubMed search using the words 'systemic lupus erythematosus' and 'therapy' . General principles of management Education and supportAt diagnosis, patients should be offered counselling and educational material, preferably by a rheumatology nurse. Lupus support groups are very beneficial. Patients should avoid sun exposure and use a daily sunscreen (sun protection factor (SPF) >50). Antimalarial therapyThe antimalarial (AM) drugs chloroquine (CQ) and hydroxy chloro quine (HQ) have been used in the treat ment of SLE for >50 years, with CQ being much more readily available in SA than HQ. Recent studies demonstrate their antiinflammatory, antithrombotic and antilipidaemic effects via multiple molecular pathways, resulting in better control of disease activity and fewer complications (Table 1). [1] Given the current evidence, all SLE patients should be prescribed an AM, and clinicians should encourage compliance. The common sideeffects of AM drugs are gastrointestinal, but these are usually mild and transient. More worrisome are skin hyperpigmentation and maculopathy. The latter is uncommon, affecting 2.5% of patients treated with CQ for 10 years (and 0.1% of patients using HQ); the major risk factor seems to be the cumulative dose of an AM.[2] If diagnosed early, and the AM is discontinued, the maculopathy is reversible. Therefore, patients on AMs should undergo ophthalmological assessment including fundoscopy, visual field tests and optical coherence tomography at baseline and annually after 5 years of CQ use. Outcomes for patients with systemic lupus erythematosus (SLE) have improved during the last two decades as our understanding of the disease expands. In particular, the importance of antimalarial therapy for addressing and preventing a host of complications in SLE has emerged. Furthermore, evidence is mounting that corticosteroids, while offering excellent control of disease activity, are responsible for many of the late complications of SLE and need to be prescribed in modest doses for the shortest time possible. To achieve this, an understanding of the available 'steroidsparing' immunosuppressants is useful. Specific attention needs to be paid to the two most important complications of SLE, i.e. infections and atherosclerotic cardiovascular events. Awareness of, screening for and aggressive management of risk factors for these comorbiditie...

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A study of erosive phenotypes in lupus arthritis using magnetic resonance imaging and anti-citrullinated protein antibody, anti-RA33 and RF autoantibody status

Abstract: An MRI-determined joint erosive phenotype is common in SLE, even in ACPA-negative cases. The conventional radiographic observation that anti-RA33 is not positively associated with erosion in patients with RA was also found to be the case in SLE patients.

Cited by 39 publications

References 43 publications

Antibodies against carbamylated proteins and cyclic citrullinated peptides in systemic lupus erythematosus: results from two well-defined European cohorts

Antibodies against carbamylated proteins and cyclic citrullinated peptides in systemic lupus erythematosus: results from two well-defined European cohorts

Evaluation of clinical and laboratory findings of 147 patients with systemic lupus erythematosus: The relationship between anti-CCP and arthritis

Evidence-based treatment of systemic lupus erythematosus and its complications

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