Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2005 Feb 4;64(8):1145–1149. doi: 10.1136/ard.2004.032177

Anti-citrullinated peptide antibodies may occur in patients with psoriatic arthritis

C Vander 1, I Hoffman 1, H Zmierczak 1, M Van den Berghe 1, E Kruithof 1, L De Rycke 1, H Mielants 1, E Veys 1, D Baeten 1, F De Keyser 1
PMCID: PMC1755603  PMID: 15695535

Abstract

Background: Anti-cyclic citrullinated peptide (anti-CCP) antibodies are considered highly specific markers of rheumatoid arthritis. Despite the high specificity of the test, anti-CCP antibodies have also been observed in psoriatic arthritis.

Objective: To determine the frequency of anti-CCP antibodies in psoriatic arthritis and to describe the clinical characteristics of such patients.

Methods: Serum samples from 192 patients with psoriatic arthritis were analysed for anti-CCP antibodies. A previously defined cut off point was applied at a specificity level of ⩾98.5% (42 U/ml). Antibodies against pepA and pepB (two synthetic citrullinated peptides) were determined on samples containing anti-CCP antibodies by line immune assay. The swollen joint count and the numbers of affected joints (present or past) were recorded. Clinical features were noted and if available radiographs of hands and feet were scored for erosions. Rheumatoid factor was determined in all samples.

Results: Anti-CCP antibodies were found in 15 patients (7.8%); 13 of 15 anti-CCP2 positive samples were also positive for anti-pepA or pepB antibodies. The prevalence of anti-CCP antibodies was higher than expected in view of the highly specific cut off applied in the test. Detailed analysis of the clinical and radiological features makes it improbable that the high prevalence of anti-CCP antibodies resulted solely from concomitant psoriasis and rheumatoid arthritis or from misclassification.

Conclusions: Anti-CCP antibodies may be present in patients with psoriatic arthritis. Although some of the present cohort could have had psoriasis with concomitant rheumatoid arthritis, a proportion at least had the typical characteristics of psoriatic arthritis as the primary diagnosis.

Full Text

The Full Text of this article is available as a PDF (91.5 KB).

Figure 1.

Figure 1

Open in a new tab

 Radiographs of the hands of a patient with positive anti-cyclic citrullinated peptide antibodies (male, aged 68 years), showing ankylosis of different finger interphalangeal joints.

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. Berglin Ewa, Padyukov Leonid, Sundin Ulf, Hallmans Göran, Stenlund Hans, Van Venrooij Walther J., Klareskog Lars, Dahlqvist Solbritt Rantapä. A combination of autoantibodies to cyclic citrullinated peptide (CCP) and HLA-DRB1 locus antigens is strongly associated with future onset of rheumatoid arthritis. Arthritis Res Ther. 2004 May 11;6(4):R303–R308. doi: 10.1186/ar1187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. De Rycke L., Peene I., Hoffman I. E. A., Kruithof E., Union A., Meheus L., Lebeer K., Wyns B., Vincent C., Mielants H. Rheumatoid factor and anticitrullinated protein antibodies in rheumatoid arthritis: diagnostic value, associations with radiological progression rate, and extra-articular manifestations. Ann Rheum Dis. 2004 Dec;63(12):1587–1593. doi: 10.1136/ard.2003.017574. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dougados M., van der Linden S., Juhlin R., Huitfeldt B., Amor B., Calin A., Cats A., Dijkmans B., Olivieri I., Pasero G. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991 Oct;34(10):1218–1227. doi: 10.1002/art.1780341003. [DOI] [PubMed] [Google Scholar]
  5. Dubucquoi S., Solau-Gervais E., Lefranc D., Marguerie L., Sibilia J., Goetz J., Dutoit V., Fauchais A-L, Hachulla E., Flipo R-M. Evaluation of anti-citrullinated filaggrin antibodies as hallmarks for the diagnosis of rheumatic diseases. Ann Rheum Dis. 2004 Apr;63(4):415–419. doi: 10.1136/ard.2003.008623. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Girbal-Neuhauser E., Durieux J. J., Arnaud M., Dalbon P., Sebbag M., Vincent C., Simon M., Senshu T., Masson-Bessière C., Jolivet-Reynaud C. The epitopes targeted by the rheumatoid arthritis-associated antifilaggrin autoantibodies are posttranslationally generated on various sites of (pro)filaggrin by deimination of arginine residues. J Immunol. 1999 Jan 1;162(1):585–594. [PubMed] [Google Scholar]
  7. Gladman Dafna D., Helliwell Philip, Mease Philip J., Nash Peter, Ritchlin Christopher, Taylor William. Assessment of patients with psoriatic arthritis: a review of currently available measures. Arthritis Rheum. 2004 Jan;50(1):24–35. doi: 10.1002/art.11417. [DOI] [PubMed] [Google Scholar]
  8. Harper R., Reeves B. Reporting of precision of estimates for diagnostic accuracy: a review. BMJ. 1999 May 15;318(7194):1322–1323. doi: 10.1136/bmj.318.7194.1322. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Helliwell Philip S. Relationship of psoriatic arthritis with the other spondyloarthropathies. Curr Opin Rheumatol. 2004 Jul;16(4):344–349. doi: 10.1097/01.bor.0000129717.19777.9d. [DOI] [PubMed] [Google Scholar]
  10. Hoffman I. E. A., Peene I., Cebecauer L., Isenberg D., Huizinga T. W. J., Union A., Meheus L., De Bosschere K., Hulstaert F., Veys E. M. Presence of rheumatoid factor and antibodies to citrullinated peptides in systemic lupus erythematosus. Ann Rheum Dis. 2005 Feb;64(2):330–332. doi: 10.1136/ard.2004.022111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kane D., Stafford L., Bresnihan B., FitzGerald O. A classification study of clinical subsets in an inception cohort of early psoriatic peripheral arthritis--'DIP or not DIP revisited'. Rheumatology (Oxford) 2003 Jul 16;42(12):1469–1476. doi: 10.1093/rheumatology/keg445. [DOI] [PubMed] [Google Scholar]
  12. Koó T., Nagy Z., Seszták M., Ujfalussy I., Merétey K., Böhm U., Forgács S., Szilágyi M., Czirják L., Farkas V. Subsets in psoriatic arthritis formed by cluster analysis. Clin Rheumatol. 2001;20(1):36–43. doi: 10.1007/s100670170101. [DOI] [PubMed] [Google Scholar]
  13. Lee D. M., Schur P. H. Clinical utility of the anti-CCP assay in patients with rheumatic diseases. Ann Rheum Dis. 2003 Sep;62(9):870–874. doi: 10.1136/ard.62.9.870. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Levin R. W., Park J., Ostrov B., Reginato A., Baker D. G., Bomalaski J. S., Borofsky M., Gardiner M., Leventhal L., Louthrenoo W. Clinical assessment of the 1987 American College of Rheumatology criteria for rheumatoid arthritis. Scand J Rheumatol. 1996;25(5):277–281. doi: 10.3109/03009749609104058. [DOI] [PubMed] [Google Scholar]
  15. Marsal S., Armadans-Gil L., Martínez M., Gallardo D., Ribera A., Lience E. Clinical, radiographic and HLA associations as markers for different patterns of psoriatic arthritis. Rheumatology (Oxford) 1999 Apr;38(4):332–337. doi: 10.1093/rheumatology/38.4.332. [DOI] [PubMed] [Google Scholar]
  16. McGonagle D., Conaghan P. G., Emery P. Psoriatic arthritis: a unified concept twenty years on. Arthritis Rheum. 1999 Jun;42(6):1080–1086. doi: 10.1002/1529-0131(199906)42:6<1080::AID-ANR2>3.0.CO;2-7. [DOI] [PubMed] [Google Scholar]
  17. Mediwake R., Isenberg D. A., Schellekens G. A., van Venrooij W. J. Use of anti-citrullinated peptide and anti-RA33 antibodies in distinguishing erosive arthritis in patients with systemic lupus erythematosus and rheumatoid arthritis. Ann Rheum Dis. 2001 Jan;60(1):67–68. doi: 10.1136/ard.60.1.67. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Moll J. M., Wright V. Psoriatic arthritis. Semin Arthritis Rheum. 1973;3(1):55–78. doi: 10.1016/0049-0172(73)90035-8. [DOI] [PubMed] [Google Scholar]
  19. Nielen Markus M. J., van Schaardenburg Dirkjan, Reesink Henk W., van de Stadt Rob J., van der Horst-Bruinsma Irene E., de Koning Margret H. M. T., Habibuw Moud R., Vandenbroucke Jan P., Dijkmans Ben A. C. Specific autoantibodies precede the symptoms of rheumatoid arthritis: a study of serial measurements in blood donors. Arthritis Rheum. 2004 Feb;50(2):380–386. doi: 10.1002/art.20018. [DOI] [PubMed] [Google Scholar]
  20. Palazzi C., Olivieri I., Petricca A., Salvarani C. Rheumatoid arthritis or psoriatic symmetric polyarthritis? A difficult differential diagnosis. Clin Exp Rheumatol. 2002 Jan-Feb;20(1):3–4. [PubMed] [Google Scholar]
  21. Pinheiro Geraldo Castelar, Scheinberg Morton A., Aparecida da Silva Miriam, Maciel Suely. Anti-cyclic citrullinated peptide antibodies in advanced rheumatoid arthritis. Ann Intern Med. 2003 Aug 5;139(3):234–235. doi: 10.7326/0003-4819-139-3-200308050-00021. [DOI] [PubMed] [Google Scholar]
  22. 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]
  23. 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]
  24. Suzuki K., Sawada T., Murakami A., Matsui T., Tohma S., Nakazono K., Takemura M., Takasaki Y., Mimori T., Yamamoto K. High diagnostic performance of ELISA detection of antibodies to citrullinated antigens in rheumatoid arthritis. Scand J Rheumatol. 2003;32(4):197–204. doi: 10.1080/03009740310003677. [DOI] [PubMed] [Google Scholar]
  25. Taylor William J., Helliwell Philip S. Development of diagnostic criteria for psoriatic arthritis: methods and process. Curr Rheumatol Rep. 2004 Aug;6(4):299–305. doi: 10.1007/s11926-004-0042-z. [DOI] [PubMed] [Google Scholar]
  26. Union Ann, Meheus Lydie, Humbel René Louis, Conrad Karsten, Steiner Guenter, Moereels Henri, Pottel Hans, Serre Guy, De Keyser Filip. Identification of citrullinated rheumatoid arthritis-specific epitopes in natural filaggrin relevant for antifilaggrin autoantibody detection by line immunoassay. Arthritis Rheum. 2002 May;46(5):1185–1195. doi: 10.1002/art.10229. [DOI] [PubMed] [Google Scholar]
  27. Vallbracht I., Rieber J., Oppermann M., Förger 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 Sep;63(9):1079–1084. doi: 10.1136/ard.2003.019877. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Veale D., Rogers S., Fitzgerald O. Classification of clinical subsets in psoriatic arthritis. Br J Rheumatol. 1994 Feb;33(2):133–138. doi: 10.1093/rheumatology/33.2.133. [DOI] [PubMed] [Google Scholar]
  29. Vossenaar Erik R., van Boekel Martinus A. M., van Venrooij Walther J., López-Hoyoz Marcos, Merino Jesús, Merino Ramón, Joosten Leo A. B. Absence of citrulline-specific autoantibodies in animal models of autoimmunity. Arthritis Rheum. 2004 Jul;50(7):2370–2372. doi: 10.1002/art.20296. [DOI] [PubMed] [Google Scholar]
  30. Young B. J., Mallya R. K., Leslie R. D., Clark C. J., Hamblin T. J. Anti-keratin antibodies in rheumatoid arthritis. Br Med J. 1979 Jul 14;2(6182):97–99. doi: 10.1136/bmj.2.6182.97. [DOI] [PMC free article] [PubMed] [Google Scholar]

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

RESOURCES