Anti-cyclic citrullinated peptide antibody in the cerebrospinal fluid in patients with rheumatoid arthritis who have central nervous system involvement

Higashida-Konishi, Misako; Izumi, Kiyotaka; Tsukamoto, Masako; Ohya, Hiroaki; Takasugi, Nozomi; Hama, Satoshi; Hayashi, Yoshiko; Ushikubo, Mari; Akiya, Kumiko; Araki, Kazuhiro; Okano, Yutaka; Oshima, Hisaji

doi:10.1007/s10067-020-05044-0

Cited by 14 publications

(19 citation statements)

References 42 publications

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“…It has been reported that antibody titer indices exceeding 1.3 7 suggest intrathecal production of antibodies. A few reports described the utility of the antibody titer indices of anti‐CCP antibody or CARF 2,8‐11 in the diagnosis of RM, and in our case, the antibody titer indices of these antibodies were 21.01 and 4.44, respectively. In the present case, antibody titer indices after steroid pulse therapy were not examined, but previous reports have described a decrease in the antibody titer index of anti‐CCP antibody or CARF after treatment, suggesting the usefulness of this index in assessing the efficacy of RM 9‐11 …”

Section: Discussionmentioning

confidence: 49%

A case of rheumatoid meningitis with elevated antibody titer indices of anti‐cyclic citrullinated peptide antibody and anti‐galactose‐deficient IgG antibody

Nakamura

Haryu

Kameyama

et al. 2021

Neurology & Clinical Neurosc

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Rheumatoid meningitis (RM) is a rare central nervous system manifestation of rheumatoid arthritis (RA). A meningeal biopsy is useful for diagnosis but is invasive and not very sensitive. We report about a patient with RM who was diagnosed using indices of anti‐cyclic citrullinated peptide (CCP) antibody and anti‐galactose‐deficient IgG antibody (carbohydrate in rheumatoid factor [CARF]) and who had refused to undergo biopsy. The patient's antibody titer indices of anti‐CCP antibody and CARF were 21.01 and 4.44, respectively. The patient's symptoms and abnormalities on brain magnetic resonance imaging improved after steroid therapy. Antibody titer indices of the anti‐CCP antibody and CARF can be used to diagnose RM in cases where biopsy is unavailable.

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Section: Discussionmentioning

confidence: 49%

A case of rheumatoid meningitis with elevated antibody titer indices of anti‐cyclic citrullinated peptide antibody and anti‐galactose‐deficient IgG antibody

Nakamura

Haryu

Kameyama

et al. 2021

Neurology & Clinical Neurosc

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“…However, the recurrence of neurological symptoms was most likely caused by a reduction in the dose of steroids. Since corticosteroids suppress Th1 cells that produce IL‐2, which inhibits B‐cell differentiation, 8 it is possible that treatment with steroids may have been helpful in suppressing activated T‐cell activity used by PD‐1 inhibitors in this case.…”

Section: Discussionmentioning

confidence: 98%

“…The occurrence of pembrolizumab‐induced rheumatoid meningoencephalitis is involved in the activation of T cells. Similarly, the presentation of citrullinated peptides could activate autoreactive T cells, which in turn could induce B cells and stimulate the production of anti‐CCP antibody 8 . As a result of the administration of pembrolizumab, the activation of T cells might not only induce an anti‐tumor effect but also the production of anti‐CCP antibody.…”

Section: Discussionmentioning

confidence: 99%

A case of rheumatoid meningoencephalitis induced by pembrolizumab

Matsuoka

Omote

Kawahara

et al. 2021

Neurology & Clinical Neurosc

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Immune checkpoint inhibitors occasionally cause various side effects, but the occurrence of a severe immune‐related adverse event (irAE) is rare in neurology. We report on a 56‐year‐old woman who suffered from rheumatoid arthritis and recurrent uterine cancer. After treatment with pembrolizumab, she showed visual disturbance followed by acute fever and consciousness disturbance with high‐intensity lesions around the midbrain aqueduct and bilateral caudate heads on FLAIR images of a brain MRI. Her symptoms improved after steroid therapy. However, symptoms relapsed leading to an elevation of the anti‐CCP antibody index. Pembrolizumab‐induced rheumatoid meningoencephalitis was suspected, so additional steroid therapy was provided. This improved her symptoms, turning the anti‐CCP antibody index negative. The present case is the first case of rheumatoid meningoencephalitis induced by pembrolizumab. The combination of MRI findings and elevated anti‐CCP index seems useful for diagnosing rheumatoid meningoencephalitis.

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“…It is characterized by inflammatory CSF and radiological evidence of meningeal enhancement with or without underlying parenchymal signal changes. Many of these cases indicate that rheumatoid meningitis can co-exist with high levels of anti-CCP antibodies in both the serum and CSF (12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, we did not measure the level of anti-myelin oligodendrocyte glycoprotein (MOG) antibody, which is an indicator of acute disseminated encephalomyelitis (ADEM) ( 20 ). It is also controversial that a full recovery from meningoencephalitis can be achieved using immunoglobulins, which were not used in previous reports of the treatment of rheumatoid meningoencephalitis ( 12 - 14 ). The same clinical course may be observed with other types of meningoencephalitis after COVID-19 vaccination.…”

Section: Discussionmentioning

confidence: 99%

Acute Meningoencephalitis after COVID-19 Vaccination in an Adult Patient with Rheumatoid Vasculitis

et al. 2022

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We herein report a 72-year-old woman with rheumatoid vasculitis who exhibited a depressed level of consciousness after receiving the first dose of the Pfizer-BioNTech mRNA BNT162b COVID-19 vaccine and was diagnosed with meningoencephalitis. Although there was no confirmatory examination, the diagnosis was based on magnetic resonance imaging (MRI) findings and etiological assessments, including microbiological and autoimmune investigations. Both intravenous steroid pulse and gammaglobulin therapies alleviated the patient's symptoms, and the MRI findings improved. Although the efficacy of COVID-19 vaccination has been widely accepted, such neurologic complications might occur in patients with rheumatoid diseases or vasculitis syndromes.

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Anti-cyclic citrullinated peptide antibody in the cerebrospinal fluid in patients with rheumatoid arthritis who have central nervous system involvement

Cited by 14 publications

References 42 publications

A case of rheumatoid meningitis with elevated antibody titer indices of anti‐cyclic citrullinated peptide antibody and anti‐galactose‐deficient IgG antibody

A case of rheumatoid meningitis with elevated antibody titer indices of anti‐cyclic citrullinated peptide antibody and anti‐galactose‐deficient IgG antibody

A case of rheumatoid meningoencephalitis induced by pembrolizumab

Acute Meningoencephalitis after COVID-19 Vaccination in an Adult Patient with Rheumatoid Vasculitis

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