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Abstract Number: 454

The Specificity of Anti-Carbamylated Protein Antibodies for Rheumatoid Arthritis in a Setting of Early Arthritis

Jing Shi, H.W. van Steenbergen, J. a. B. van Nies, E.W.Nivine Levarht, Annette H. M. van der Helm- van Mil, Tom W. J. Huizinga, René E.M. Toes and Leendert A. Trouw, Rheumatology, Leiden University Medical Center, Leiden, Netherlands

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: autoantibodies, diagnosis, Prognostic factors and rheumatoid arthritis (RA)

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Session Information

Session Title: Rheumatoid Arthritis - Human Etiology and Pathogenesis

Session Type: Abstract Submissions (ACR)

Background/Purpose

Anti-carbamylated protein (anti-CarP) antibodies have been described in rheumatoid arthritis (RA) and arthralgia patients [1;2] and occur in subsets of the anti-CCP2 positive and negative patients [1;3]. In anti-CCP2 negative RA patients the presence of anti-CarP was associated with more severe joint destruction [1]. Here we investigated the sensitivity and specificity of anti-CarP antibodies for RA in a setting of early arthritis.

Methods

Anti-carbamylated fetal calf serum (anti-Ca-FCS), anti-CCP2 antibodies and rheumatoid factor (RF) IgM were measured by ELISA using serum samples available from a large inception cohort; the Leiden Early Arthritis Clinic cohort (EAC). For the anti-CarP antibodies we used as a cut-off for positivity the mean + 2 times the standard deviation of the healthy controls [1].

Results

In total 2086 sera of Leiden EAC patients suffering from early arthritis were analyzed for the presence of anti-Ca-FCS antibodies. Anti-CarP antibodies were present in 26% of the patients and in 2% of the controls. We observed that the sensitivity and specificity of anti-Ca-FCS in the EAC cohort for RA are 44% and 89%. As a reference the sensitivity and specificity of anti-CCP2 antibodies are 54% and 95% and for RF IgM are 59% and 90%. Analyzing the early arthritis patients that did not fulfil the EULAR/ACR 2010 criteria for RA that were anti-CarP positive (n=127) revealed that these patients were mainly diagnosed as undifferentiated arthritis (45%), reactive arthritis (9%), psoriatic arthritis (9%) or peripheral spondyloarthritis (8%).

Conclusion

Anti-CarP antibodies, as determined by the reactivity to carbamylated FCS, are predominantly present in RA but can also be detected in other forms of arthritis. The prognostic relevance of anti-CarP antibodies in these latter patients will have to be determined.

1.    Shi J et al. Autoantibodies recognizing carbamylated proteins are present in sera of patients with rheumatoid arthritis and predict joint damage. Proc.Natl.Acad.Sci.U.S.A 2011; 108:17372-7.

2.    Shi J, van de Stadt LA, et al. Anti Carbamylated Protein Antibodies (anti-CarP) are present in arthralgia patients and predict the development of rheumatoid arthritis. Arthritis Rheum. 2012.

3.    Jiang X, Trouw LA, et al. Anti-CarP antibodies in two large cohorts of patients with rheumatoid arthritis and their relationship to genetic risk factors, cigarette smoking and other autoantibodies. Ann.Rheum.Dis. 2014.


Disclosure:

J. Shi,
None;

H. W. van Steenbergen,
None;

J. A. B. van Nies,
None;

E. W. N. Levarht,
None;

A. H. M. van der Helm- van Mil,
None;

T. W. J. Huizinga,
None;

R. E. M. Toes,
None;

L. A. Trouw,
None.

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