Anti-citrullinated protein antibodies are linked to erosive disease in an observational study of patients with psoriatic arthritis

Abstract

Objective. ACPAs are associated with bone destruction in RA. The aim of this study was to evaluate the association between ACPA and bone destruction in patients with a distinct inflammatory disorder, PsA.Methods. We used baseline data from a large observational study of PsA patients preparing to initiate treatment with adalimumab to analyse demographic and disease characteristics by ACPA status. To ensure a homogeneous PsA study population, only patients with active psoriatic skin manifestations who met Classification of Psoriatic Arthritis criteria for PsA were included in the analyses, thereby minimizing the risk of including misdiagnosed RA patients. Multiple logistic regression analyses were used to explore potential associations between ACPA seropositivity and bone destruction.Results. Of 1996 PsA patients who met the strict inclusion criteria, 105 (5.3%) were positive for ACPA. ACPA-positive patients had significantly higher swollen joint counts and 28-joint DAS values than ACPA-negative patients and significantly higher rates of erosive changes and dactylitis. Multiple logistic regression analysis confirmed the association of ACPA seropositivity with a 2.8-fold increase in the risk of erosive disease.Conclusion. As has been previously shown for RA, ACPA is associated with bone destruction in PsA, suggesting that the osteocatabolic effect of ACPA is not confined to RA but is also detectable in the different pathogenetic context of a distinct disease entity.Trial registration: ClinicalTrials.gov, NCT01111240

Association of Anti-Cyclic Citrullinated Peptide Antibody in a Sample of Adult Patients With Psoriasis and Psoriatic Arthropathy

“…There were no differences between ACPApositive and ACPA-negative PsA patients in terms of gender, age, and disease duration. The lack of this association in our study is in agreement with the results of Popescu et al, Abdel Fattah et al, and Behrens et al [13,20,21]. There were no significant differences between ACPApositive and ACPA-negative PsA patients in terms of CRP, RF, and ESR also, with an agreement to the study of Popescu et al [20].…”

“…Another important clinical characteristic is polyarthritis pattern which was statistically non-significant in our study, similar results were described in studies done by Korendowych et al and Behren et al [18,21]. The latter was the largest study; 1996 patients with PsA were included in the study, of which 105 patients were ACPA positive [21]. On the other hand, other studies showed an association of ACPA seropositivity with polyarthritis [13,15,20,22,23].…”

“…Another possible issue is their use of DAS 68 score which is different DAS. Another important clinical characteristic is polyarthritis pattern which was statistically non-significant in our study, similar results were described in studies done by Korendowych et al and Behren et al [18,21]. The latter was the largest study; 1996 patients with PsA were included in the study, of which 105 patients were ACPA positive [21].…”

“…There were no significant differences between ACPApositive and ACPA-negative PsA patients in terms of CRP, RF, and ESR also, with an agreement to the study of Popescu et al [20]. Regarding disease activity, statistically significant difference in mean of DAS 28 score (5.5) was found in ACPA-positive patients when compared with ACPA-negative patients (4.5) (p=0.044), this was in agreement with some studies such as Abdel Fattah et al, Bogliolo et al, Korendowych et al, Perez-Alamino et al, and Behren et al [13,15,18,21,22] while another study such as Alenius et al and Cruyssen et al disagrees with us [12,17]. This contradiction may have its origin in the difference in genetics and race in contradicted studied groups.…”

Differential expression of programmed death 1 (PD-1) on CD4+ and CD8+ T cells in rheumatoid arthritis and psoriatic arthritis

“…25 Moreover, it is known that both RF and anti -CCP antibody titers may be negative in about 12% to 30% of patients with RA, whereas in patients with PsA, the positive anti -CCP antibody titer is present in 5.6% to 20% of patients while from 5% to 10% of patients are positive for RF. [26][27][28] Also, the majority of patients positive for anti -CCP antibodies showed polyarticular joint involvement or erosive changes and other forms of bone destruction mimicking RA; thus, sensitive and specific diagnostic tools are still needed. In our small group of 9 patients (29.03%) with polyarticular symmetric PsA, PD -1 expression on CD4 + and CD8 + was not significantly different from that observed in patients with other clinical subsets of PsA.…”