Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2004 Jul 1;64(1):114–117. doi: 10.1136/ard.2003.019794

Prevalence of anti-cyclic citrullinated peptide and anti-keratin antibodies in patients with primary Sjögren's syndrome

J Gottenberg 1, S Mignot 1, P Nicaise-Rolland 1, J Cohen-Solal 1, F Aucouturier 1, J Goetz 1, C Labarre 1, O Meyer 1, J Sibilia 1, X Mariette 1
PMCID: PMC1755190  PMID: 15231509

Abstract

Objective: To investigate the prevalence of anti-cyclic citrullinated peptide (anti-CCP) and anti-keratin antibodies (AKA) in patients with primary Sjögren's syndrome.

Methods: 149 patients with a diagnosis of primary Sjögren's syndrome according to the European/American consensus criteria were recruited from three French medical centres. The presence of anti-CCP was determined by enzyme linked immunosorbent assay and of AKA antibodies by indirect immunofluorescence. Radiographs of hands and feet were evaluated at the time of anti-CCP analysis.

Results: Six patients with radiological erosions and nine patients with non-erosive arthritis fulfilling ACR criteria for rheumatoid arthritis were thought to have rheumatoid arthritis and secondary Sjögren's syndrome, while 134 were considered to have primary Sjögren's syndrome (mean (SD) disease duration, 11.1 (6.6) years). Of these, 80 tested positive for IgM rheumatoid factor (RF) (59%), 10 (7.5%) for anti-CCP, 7 (5.2%) for AKA, and 5 (3.7%) for both anti-CCP and AKA. There was no difference in clinical and biological features, including prevalence of RF, between anti-CCP positive and negative patients. The nine Sjögren patients with non-erosive arthritis, fulfilling ACR criteria for rheumatoid arthritis, were all CCP positive. Their response to disease modifying antirheumatic drugs could be different from classical rheumatoid patients.

Conclusions: Most patients with primary Sjögren's syndrome are negative for AKA and anti-CCP, but positive test results should not rule out this diagnosis. Anti-CCP positive patients, who may be prone to developing rheumatoid arthritis, require cautious clinical and radiographic follow up.

Full Text

The Full Text of this article is available as a PDF (58.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
  2. Bizzaro N., Mazzanti G., Tonutti E., Villalta D., Tozzoli R. Diagnostic accuracy of the anti-citrulline antibody assay for rheumatoid arthritis. Clin Chem. 2001 Jun;47(6):1089–1093. [PubMed] [Google Scholar]
  3. Gottenberg Jacques-Eric, Busson Marc, Loiseau Pascale, Cohen-Solal Julien, Lepage Virginia, Charron Dominique, Sibilia Jean, Mariette Xavier. In primary Sjögren's syndrome, HLA class II is associated exclusively with autoantibody production and spreading of the autoimmune response. Arthritis Rheum. 2003 Aug;48(8):2240–2245. doi: 10.1002/art.11103. [DOI] [PubMed] [Google Scholar]
  4. Hill Jonathan A., Southwood Scott, Sette Alessandro, Jevnikar Anthony M., Bell David A., Cairns Ewa. Cutting edge: the conversion of arginine to citrulline allows for a high-affinity peptide interaction with the rheumatoid arthritis-associated HLA-DRB1*0401 MHC class II molecule. J Immunol. 2003 Jul 15;171(2):538–541. doi: 10.4049/jimmunol.171.2.538. [DOI] [PubMed] [Google Scholar]
  5. Manoussakis M. N., Tzioufas A. G., Pange P. J., Moutsopoulos H. M. Serological profiles in subgroups of patients with Sjögren's syndrome. Scand J Rheumatol Suppl. 1986;61:89–92. [PubMed] [Google Scholar]
  6. Mariette X., Roux S., Zhang J., Bengoufa D., Lavie F., Zhou T., Kimberly R. The level of BLyS (BAFF) correlates with the titre of autoantibodies in human Sjögren's syndrome. Ann Rheum Dis. 2003 Feb;62(2):168–171. doi: 10.1136/ard.62.2.168. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Meyer O., Labarre C., Dougados M., Goupille Ph, Cantagrel A., Dubois A., Nicaise-Roland P., Sibilia J., Combe B. Anticitrullinated protein/peptide antibody assays in early rheumatoid arthritis for predicting five year radiographic damage. Ann Rheum Dis. 2003 Feb;62(2):120–126. doi: 10.1136/ard.62.2.120. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Paimela L., Palosuo T., Aho K., Lukka M., Kurki P., Leirisalo-Repo M., von Essen R. Association of autoantibodies to filaggrin with an active disease in early rheumatoid arthritis. Ann Rheum Dis. 2001 Jan;60(1):32–35. doi: 10.1136/ard.60.1.32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Pertovaara M., Pukkala E., Laippala P., Miettinen A., Pasternack A. A longitudinal cohort study of Finnish patients with primary Sjögren's syndrome: clinical, immunological, and epidemiological aspects. Ann Rheum Dis. 2001 May;60(5):467–472. doi: 10.1136/ard.60.5.467. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Rantapä-Dahlqvist Solbritt, de Jong Ben A. W., Berglin Ewa, Hallmans Göran, Wadell Göran, Stenlund Hans, Sundin Ulf, van Venrooij Walther J. Antibodies against cyclic citrullinated peptide and IgA rheumatoid factor predict the development of rheumatoid arthritis. Arthritis Rheum. 2003 Oct;48(10):2741–2749. doi: 10.1002/art.11223. [DOI] [PubMed] [Google Scholar]
  11. Schellekens G. A., Visser H., de Jong B. A., van den Hoogen F. H., Hazes J. M., Breedveld F. C., van Venrooij W. J. The diagnostic properties of rheumatoid arthritis antibodies recognizing a cyclic citrullinated peptide. Arthritis Rheum. 2000 Jan;43(1):155–163. doi: 10.1002/1529-0131(200001)43:1<155::AID-ANR20>3.0.CO;2-3. [DOI] [PubMed] [Google Scholar]
  12. Sebbag M., Simon M., Vincent C., Masson-Bessière C., Girbal E., Durieux J. J., Serre G. The antiperinuclear factor and the so-called antikeratin antibodies are the same rheumatoid arthritis-specific autoantibodies. J Clin Invest. 1995 Jun;95(6):2672–2679. doi: 10.1172/JCI117969. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Vencovský J., Machácek S., Sedová L., Kafková J., Gatterová J., Pesáková V., Růzicková S. Autoantibodies can be prognostic markers of an erosive disease in early rheumatoid arthritis. Ann Rheum Dis. 2003 May;62(5):427–430. doi: 10.1136/ard.62.5.427. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Vitali C., Bombardieri S., Jonsson R., Moutsopoulos H. M., Alexander E. L., Carsons S. E., Daniels T. E., Fox P. C., Fox R. I., Kassan S. S. Classification criteria for Sjögren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002 Jun;61(6):554–558. doi: 10.1136/ard.61.6.554. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Young A., Corbett M., Winfield J., Jaqueremada D., Williams P., Papasavvas G., Hay F., Roitt I. A prognostic index for erosive changes in the hands, feet, and cervical spines in early rheumatoid arthritis. Br J Rheumatol. 1988 Apr;27(2):94–101. doi: 10.1093/rheumatology/27.2.94. [DOI] [PubMed] [Google Scholar]
  16. van Rossum Marion, van Soesbergen Renée, de Kort Sandra, ten Cate Rebecca, Zwinderman Aeilko H., de Jong Ben, Dijkmans Ben, van Venrooij Walther J. Anti-cyclic citrullinated peptide (anti-CCP) antibodies in children with juvenile idiopathic arthritis. J Rheumatol. 2003 Apr;30(4):825–828. [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES