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Background: Rheumatoid arthritis (RA) is a systemic chronic infl ammatory disease of the joint that causes deformity or disability leading to a decreased function in RA patients. According to the 1987 American College of Rheumatology, rheumatoid factor (RF) is used as one of the diagnostic criteria because until today it is still considered as the primary autoantibody in RA although it has a lower specifi city than that of anticyclic citrullinated peptide (anti-CCP). Besides RF and anti-CCP, anti-RA33 is another autoantibody found. The
presence of the three autoantibodies in RA patient serum is important because it is the starting point of the pathogenesis of the autoimmune process in RA.
Methods: This is a cross-sectional study using consecutive sampling. Forty six subjects, all suffering from RA, were recruited for this study. All of them were tested for RF, anti-CCP, anti-RA33 titers using enzymelinked immunosorbent assay (ELISA) method and had
their hand radiograph taken to obtain the Sharp score to evaluate joint damage. During this study, 28-joint Disease Activity Score (DAS28) (4 parameters) was also evaluated using erythrocyte sedimentation rate as one of the parameters.
Results: The study found that the correlation between the three antibodies and DAS28 was not statistically signifi cant: RF (r = 0.200, p = 0.091), anti-CCP (r =0.117, p = 0.220), and anti-RA33 (r = 0.126, p = 0.202). There was a signifi cant correlation between antiCCP and the Sharp score (r = 0.300, p = 0.021). The correlation between the other two autoantibodies and the Sharp score was not statistically significant:RF (r = 0.194, p = 0.098), anti-RA33 (r = 0.156, p = 0.150).
Conclusion: There was a signifi cant correlation between anti-CCP autoantibody andÂ radiographic hand joint damage in RA patients so that it could be used as an indicator for occurrence of an erosive or a more severe RA.
- Palferman TG. Principles of rheumatoid arthritis control. J Rheumatol 2003;30 Suppl 67:10â€“3.
- Le LoÃ«t X, Berthelot JM, Cantagrel A, Combe B, De Bandt M, FautrelB, et al. Clinical practice decision tree for the choice of the fi rst disease modifying antirheumatic drug for very early rheumatoid arthritis: a 2004 proposal of the French Society of Rheumatology. Ann Rheum Dis 2006;65:45â€“50.
- van der Helm-van Mil AHM, Huizinga TWJ. Advances in the genetics of rheumatoid arthritis point to subclassifi cation into distinct disease subsets. Arthritis Research & Therapy 2008;10:205â€“12.
- Bridges SL, Davidson A. Rheumatoid factor. In: Koopman WJ, Moreland LW, editors. Arthritis and allied conditions: a textbook of rheumatology. 15th ed. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 1227â€“40.
- BÃ¸rretzen M, Mellbye OJ, Thompson KM, Natvig JB. Rheumatoid factors. In: Peter JB, Shoenfeld Y, editors. Autoantibodies. Amsterdam: Elsevier Science B.V.; 1996. p. 706â€“12.
- Westwood OMR, Nelson PN, Hay FC. Rheumatoid factors: whatâ€™s new? Rheumatology 2006;45:379â€“85.
- Knijff-Dutmer E, Drossaers-Bakker W, Verhoeven A, Van Der Sluijs Veer G, Boers M, van Der Linden S, van De Laar M. Rheumatoid factor measured by fl uoroimmunoassay: a responsive measure of rheumatoid arthritis disease activity that is associated with joint damage. Ann Rheum Dis 2002;61:603â€“7.
- Vallbracht I, Rieber J, Oppermann M, FÃ¶rger F, Siebert U, Helmke K.Diagnostic and clinical value of anti-cyclic citrullinated peptide antibodies compared with rheumatoid factor isotypes in rheumatoid arthritis. Ann Rheum Dis 2004;63:1079â€“84.
- De Rycke L, Peene I, Hoffman IEA, Kruithof E, Union A, Meheus L, et al. Rheumatoid factor and anti-citrullinated protein antibodies in rheumatoid arthritis: diagnostic value, associations with radiological progression rate, and extra-articular manifestations. Ann Rheum Dis 2004;63:1587â€“93.
- Bas S, Perneger TV, Seitz M, Tiercy JM, Roux-Lombard P, Guerne PA. Diagnostic tests for rheumatoid arthritis: comparison of anticyclic citrullinated peptide antibodies, antikeratin antibodies and IgM rheumatoid factors. Rheumatology 2002;41:809â€“14.11. 11.Mewar D, Marinou I, Coote AL, Moore DJ, Akil M, Smillie D, et al. Association between radiographic severity of rheumatoid arthritis and shared epitope alleles: differing mechanisms of susceptibility andprotection. Ann Rheum Dis 2008;67:980â€“3.
- Zendman AJW, van Venrooij WJ, Pruijn GJM. Use and signifi cance of antiCCP autoantibodies in rheumatoid arthritis. Rheumatology 2006;45:20â€“5.
- Mattey DL, Dawes PT, Clarke S, Fisher J, Brownfi eld A, Thomson W, et al. Relationship among the HLA-DRB1 shared epitope, smoking, and rheumatoid factor production in rheumatoid arthritis. Arthritis & Rheumatism 2002;47:403â€“7.
- Rantapaa-Dahlqvist S, de Jong BA, Berglin E, Hallmans G, Wadell G, Stenhhund H, et al. Antibodies against cyclic citrulinated peptide and IgA rheumatoid factor predict the development of rheumatoid arthritis.Arthritis Rheum 2003;48:2741â€“9.
- Meyer O, Labarre C, Dougados M, Goupille Ph, Cantagrel A, Dubois A, et al. Anti-citrullinated protein/peptide antibody assays in early rheumatoid arthritis for predicting fi ve year radiographic damage. Ann Rheum Dis 2003;62:120â€“6.
- Bukhari M, Thomson W, Naseem H, Bunn D, Silman A, Symmons D, Barton A. The performance of anti-cyclic citrullinated peptide antibodies in predicting the severity of radiologic damage in infl ammatory polyarthritis. Arthritis Rheum 2007;56:2929â€“35.
- Forslind K, Ahlmen M, Eberhardt K, Svensson B. Prediction of radiological outcome in early rheumatoid arthritis in clinical practice: role of antibodies to citrullinated peptides (anti-CCP). Ann Rheum Dis 2004;63:1090â€“5.
- Syversen SW, Gaarder PI, Goll GL, Ã˜degÃ¥rd S, Haavardsholm EA, Mowinckel P, van der Heidje D, LandewÃ© R, Kvien TK. High anti-cyclic citrullinated peptide levels and an algorithm of four variables predict radiographic progression in patients with rheumatoid arthritis: results from a 10-year longitudinal study. Ann Rheum Dis 2008;67:212â€“7.
- Liao KP, Batra KL, Chibnik L, Schur PH, Costenbader KH. Anti-CCP criteria for the classifi cation of rheumatoid arthritis. Ann Rheum Dis 2008:615â€“9.
- Vossenaar ER, Zendman AJW, van Venrooij WJ. Citrullination, a possible
- functional link between susceptibility genes and rheumatoid arthritis. Arthritis Res Ther 2004, 6:1â€“5.
- Quinn MA, Gough AKS, Green MJ, Devlin J, Hensor MA, Greenstein A, Fraser A, Emery P. Anti-CCP antibodies measured at disease onset help identify seronegative rheumatoid arthritis and predict radiological and functional outcome. Rheumatology 2005;45:478â€“80.
- Mediwake R, Isenberg DA, Schellekens GA, van Venrooij WJ. Use of anticitrullinated peptide and anti-RA33 antibodies in distinguishing erosive arthritis in patients with systemic lupus erythematosus and rheumatoid arthritis. Ann Rheum Dis 2001;60:67â€“8