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Abstract Number: 2464

Characterization of the Serum Anti-Citrullinated Protein Antibody Profile in Juvenile Idiopathic Arthritis: Association with Oral Health

Sampath Prahalad1, Lauren J. Lahey2, Geoffrey M. Thiele3, Lori Ponder1, Sheila T. Angeles-Han1, Lauren Lange4, Aimee O. Hersh5, Mina Rohani-Pichavant1, Se Ryeong Jang1, Larry B. Vogler1, Patricia Vega-Fernandez1, Kelly A. Rouster-Stevens1, John F. Bohnsack6, Ted R. Mikuls7 and Jeremy Sokolove8, 1Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, 2Medicine, VA Palo Alto HealthCare System and Stanford University, Palo Alto, CA, 3Omaha VA Medical Center and University of Nebraska Medical Center, Omaha, NE, 4Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 5Pediatrics/Rheumatology, University of Utah, Salt Lake City, UT, 6Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT, 7Veteran Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, NE, 8Stanford University, Palo Alto, CA

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: anti-CCP antibodies, anti-citrullinated protein/peptide antibodies (ACPA), juvenile idiopathic arthritis-enthesitis (ERA) and oral

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Session Information

Date: Tuesday, November 10, 2015

Title: Pediatric Rheumatology - Pathogenesis and Genetics Poster

Session Type: ACR Poster Session C

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

Background/Purpose: Juvenile idiopathic arthritis (JIA) is
the most common chronic childhood arthropathy. Most children with JIA
phenotypically differ from adults with rheumatoid arthritis (RA) although some children
resemble RA by demonstrating rheumatoid factor (RF) and anti-cyclic citrullinated
peptide antibodies (CCP). Our objective was to characterize the association
between anti-citrullinated protein antibodies (ACPA) and several clinical/epidemiological
features in children with CCP-positive and CCP-negative JIA.

Methods:   Cases were 157 children with JIA. (73
CCP-/RF-; 12 CCP-/RF+; 9 CCP+/RF-; 63 CCP+/RF+), mostly female (80%), with a
mean onset age of 8.6 years. Oral health and smoking exposure history were
available on 107 cases.  Stored serum/plasma samples were evaluated for reactivity
to 30 citrullinated peptide/protein antigens and 7 native controls using a
multiplex antigen array. Significance analysis of microarrays (SAM) was used to
analyze a multiplex of specific ACPAs among JIA cases to identify differences
in ACPA profiles associated with variables. False-discovery corrected
significance values <5% were considered statistically significant.

Results: All ACPA evaluated were significantly
different between CCP-/RF-, CCP-/RF+, CP+/RF-, and CCP+/RF+ subjects with JIA
(q value <0.1%). Figure 1 is a heatmap demonstrating increased levels of
several antigen-specific ACPAs in seropositive JIA patients. Among CCP+
children, those who reported having no dental caries had significantly less
ACPAs compared to those who reported having dental caries (Figure 2). Several
other variables were also associated with significant differences in ACPA
positivity among children with CCP+ JIA (Table 1). 

Conclusion:   Children with JIA positive for both
CCP and RF demonstrate significantly increased antibody response to a variety
of citrullinated antigens compared to children who are CCP and RF negative, as
well as those who are positive for either CCP or RF alone. This suggests that CCP
and RF-positive JIA is phenotypically similar to adult seropositive RA.
Presence of dental caries may be associated with increased ACPA subtypes in
children with CCP-positive JIA.

Acknowledgements: NIAMS (AR060893), The Arthritis Foundation, The Marcus Foundation
Inc. 

 

Criteria

Group 1

Group 2

Number of ACPAs

Q value

Significant associations with ACPA

Dental caries

Absent

Present

13

<0.1%

Regular flossing

Absent

Present

9

<0.1%

Pain on chewing

Absent

Present

17

<0.1%

Regular brushing

Absent

Present

11

<0.1%

Onset age

<9

>9

7

<0.1 %

Red/swollen gums

Absent

Present

7

<0.1 %

Anti P Intermedia

Lowest ½

Highest ½

16

4.7 %

Not significantly associated with ACPA

Anti P gingivalis

Lowest ½

Highest ½

17

NS

Anti F Nucleatum

Lowest ½

Highest ½

16

NS

Smoking exposure

Absent

Present

18

NS


Disclosure: S. Prahalad, Novartis, 9; L. J. Lahey, None; G. M. Thiele, None; L. Ponder, None; S. T. Angeles-Han, This study is supported by the National Eye Institute K23-EY021760 (Dr. Angeles-Han)., 2; L. Lange, None; A. O. Hersh, None; M. Rohani-Pichavant, None; S. R. Jang, None; L. B. Vogler, None; P. Vega-Fernandez, None; K. A. Rouster-Stevens, None; J. F. Bohnsack, Novartis Pharmaceutical Corporation, 5; T. R. Mikuls, None; J. Sokolove, Bristol-Myers Squibb, 2.

To cite this abstract in AMA style:

Prahalad S, Lahey LJ, Thiele GM, Ponder L, Angeles-Han ST, Lange L, Hersh AO, Rohani-Pichavant M, Jang SR, Vogler LB, Vega-Fernandez P, Rouster-Stevens KA, Bohnsack JF, Mikuls TR, Sokolove J. Characterization of the Serum Anti-Citrullinated Protein Antibody Profile in Juvenile Idiopathic Arthritis: Association with Oral Health [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/characterization-of-the-serum-anti-citrullinated-protein-antibody-profile-in-juvenile-idiopathic-arthritis-association-with-oral-health/. Accessed .
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