Anti-citrullinated Vimentin Antibodies Are Associated to Early Deterioration of Cortical Bone and Volumetric Bone Mineral Density in Finger Joints in RA-at-risk Patients

Georg Schett¹, David Simon ², Axel Hueber ², Holger Bang ³, Jürgen Rech ⁴, Gerhard Kroenke ⁵ and Arnd Kleyer ⁶, ¹Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany, ²Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Bayern, Germany, ³Orgentec Diagnostika, 55129 Mainz, Germany, Mainz, ⁴Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany, ⁵Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Austria, ⁶Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany, Erlangen, Germany

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: ACPA, anti-mutated citrullinated vimentin, Bone and imaging techniques

Session Information

Date: Sunday, November 10, 2019

Title: RA – Diagnosis, Manifestations, & Outcomes Poster I: Risk Factors, Predictors, & Prognosis

Session Type: Poster Session (Sunday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Autoimmunity, characterized by the presence of anti-modified protein antibodies (AMPA), recognizing citrullinated, carbamylated or acetylated proteins, as well as rheumatoid factor (RF) precedes the onset of manifest rheumatoid arthritis (1,2).High resolution peripheral quantitative (HR-pQCT) technique is able to visualize marginal cortical changes in peripheral joints (3).To evaluate presence of deterioration of cortical bone as well as volumetric bone mineral density in finger joints using HR-pQCT technique and correlate these findings to arthritis specific autoimmunity, particularly osteoclast-inducing citrullinated vimentin (cVIM) antibodies and their impact on the later development of RA.

Methods: Patients were part of our individuals at risk cohort Erlangen (ethics approval 333_16B) comprising patients with AMPAs but without clinical manifest arthritis. These patients are regularly followed for arthritis development. Patients receive HR-pQCT scans as part of the protocol analyzing cortical micro-channels (CoMiCs) as well as volumetric cortical and trabecular bone densities of MCP joints as described before (3). Anti-modified protein antibody (AMPA) response was profiled including reactivities against citrullinated proteins (vimentin, enolase, fibrinogen) as well as carbamylated and acetylated vimentin from serum samples at time points

Results: 75 RA at risk patients were included. Patients with high-level ( >1000U) cVIM antibodies showed a broader AMPA response. Those patients also displayed more severe deterioration of cortical bone (higher CoMiCs, lower cortical and trabecular bone volume) compared to subjects with low/no cVIM reactivity. High cVIM antibodies and microstructural changes ( >15 radial CoMiCs/joint) were associated with the presence of arthralgia. Furthermore, progression to RA was high in subjects with

high cVIM (53%) vs. those with low (22%) or no (5%) antibodies and those with microstructural changes (46%) vs. those without such changes (16%).

Conclusion: HR-pQCT technique detects earliest deterioration of cortical bone and volumetric bone mineral density in finger Joints with association to cVIM antibodies. These data support the concept of a non-silent form of autoimmunity regarding bone changes before the onset of RA.

Disclosure: G. Schett, AbbVie, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer, 8, AbbVie, BMS, Celgene, Janssen, Lilly, Novartis, UCB, 5, BMS, Celgene, GSK, Lilly, Novartis, 2; D. Simon, None; A. Hueber, None; H. Bang, Orgentec, 3; J. Rech, AbbVie, 8, Biogen, 8, BMS, 5, 8, Celgene, 5, 8, Chugai, 5, MSD, 8, Novartis, 5, 8, Roche, 5; G. Kroenke, None; A. Kleyer, None.

To cite this abstract in AMA style:

Schett G, Simon D, Hueber A, Bang H, Rech J, Kroenke G, Kleyer A. Anti-citrullinated Vimentin Antibodies Are Associated to Early Deterioration of Cortical Bone and Volumetric Bone Mineral Density in Finger Joints in RA-at-risk Patients [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/anti-citrullinated-vimentin-antibodies-are-associated-to-early-deterioration-of-cortical-bone-and-volumetric-bone-mineral-density-in-finger-joints-in-ra-at-risk-patients/. Accessed .

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