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Di Matteo A, Mankia K, Garcia-Montoya L, Sharrack S, Duquenne L, Nam JL, Mahler M, Emery P. Utility of testing for third-generation anticyclic citrullinated peptide (anti-CCP3) antibodies in individuals who present with new musculoskeletal symptoms but have a negative second-generation anticyclic citrullinated peptide (anti-CCP2) antibody test. RMD Open 2024; 10:e003927. [PMID: 38599655 PMCID: PMC11015229 DOI: 10.1136/rmdopen-2023-003927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/22/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES To investigate the role of third-generation anticyclic citrullinated peptide (anti-CCP3) antibodies in predicting progression to inflammatory arthritis (IA) in individuals with new musculoskeletal (MSK) symptoms and a negative second-generation anti-CCP antibody test (anti-CCP2-). METHODS 469 anti-CCP2- individuals underwent baseline anti-CCP3 testing (QUANTA Lite CCP3; Inova Diagnostics) and received a post enrolment 12-month questionnaire. A rheumatologist confirmed or excluded diagnosis of IA. Univariable/multivariable analyses were performed to assess the value of anti-CCP3 in predicting IA development in these anti-CCP2- individuals. RESULTS Only 16/469 (3.4%) anti-CCP2- individuals had a positive anti-CCP3 test. Of these 16 individuals, 4 developed IA. In addition, 61/469 (13.0%) anti-CCP2- individuals self-reported, to have developed, IA. Progression was confirmed in 43/61 of them (70.5%); of whom 30/43 (69.8%) and 13/43 (30.2%) were given a diagnosis of IA and rheumatoid arthritis (RA), respectively. In qualitative univariable analysis, anti-CCP3 positivity was associated with self-reported progression (p<0.01) and IA (p=0.03), but not with RA. Anti-CCP3 levels differed significantly between progressors and non-progressors (p<0.01) for all three categories. At the manufacturer's cut-off, OR for progression ranged from 2.4 (95% CI 0.5 to 18.6; RA) to 7.5 (95% CI 2.3 to 24.0; self-reported progression). Interestingly, when cut-offs for anti-CCP3 were optimised, lower values (≥5 units) significantly increased the OR for progression in all three categories. In multivariable analysis, anti-CCP3 positivity at the manufacturer's cut-off did not remain associated with IA progression, while this lower cut-off value (≥5 units) was associated with diagnosis of RA (p=0.02). CONCLUSIONS Anti-CCP3 testing could improve the prediction of IA development in anti-CCP2- individuals with new MSK symptoms.
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Affiliation(s)
- Andrea Di Matteo
- Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Leticia Garcia-Montoya
- Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sana Sharrack
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Laurence Duquenne
- Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Michael Mahler
- Werfen Autoimmunity Technology Center, San Diego, California, USA
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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O'Neil LJ, Alpízar-Rodríguez D, Deane KD. Rheumatoid Arthritis: The Continuum of Disease and Strategies for Prediction, Early Intervention, and Prevention. J Rheumatol 2024; 51:337-349. [PMID: 38224993 PMCID: PMC10984790 DOI: 10.3899/jrheum.2023-0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/17/2024]
Abstract
Rheumatoid arthritis (RA) is known to include a pre-RA stage that can be defined as the presence of familial or genetic risk factors, biomarker abnormalities (eg, anticitrullinated protein antibodies [ACPA]), symptoms, and even abnormal imaging findings prior to the development of the onset of clinical RA with inflammatory arthritis that is apparent on physical examination. Indeed, there are multiple completed or ongoing retrospective case-control as well as prospective observational studies to identify the key biologic drivers of disease. Further, building on the predictive ability of combinations of biomarkers, symptoms, and imaging for future RA, there are multiple clinical trials completed, underway, or in development to identify approaches that may prevent, delay, or ameliorate future clinical RA in at-risk individuals. Importantly, however, although an effective preventive intervention has not yet been identified, at-risk individuals are being increasingly identified in clinical care; this presents a challenge of how to manage these individuals in clinical practice. This review will discuss the current understanding of the biology and natural history of RA development, nomenclature, and current models for prediction of future RA, as well as evaluate the current and ongoing clinical prevention trials with the overall goal to provide insights into the challenges and opportunities in the field of RA prevention. Moreover, this review will provide up-to-date options for clinical management of individuals at risk for RA.
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Affiliation(s)
- Liam J O'Neil
- L.J. O'Neil, MD, MHSc, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Kevin D Deane
- K.D. Deane, MD, PhD, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA.
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James EA, Holers VM, Iyer R, Prideaux EB, Rao NL, Rims C, Muir VS, Posso SE, Bloom MS, Zia A, Elliott SE, Adamska JZ, Ai R, Brewer RC, Seifert JA, Moss L, Barzideh S, Demoruelle MK, Striebich CC, Okamoto Y, Sainbayar E, Crook AA, Peterson RA, Vanderlinden LA, Wang W, Boyle DL, Robinson WH, Buckner JH, Firestein GS, Deane KD. Multifaceted immune dysregulation characterizes individuals at-risk for rheumatoid arthritis. Nat Commun 2023; 14:7637. [PMID: 37993439 PMCID: PMC10665556 DOI: 10.1038/s41467-023-43091-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 10/30/2023] [Indexed: 11/24/2023] Open
Abstract
Molecular markers of autoimmunity, such as antibodies to citrullinated protein antigens (ACPA), are detectable prior to inflammatory arthritis (IA) in rheumatoid arthritis (RA) and may define a state that is 'at-risk' for future RA. Here we present a cross-sectional comparative analysis among three groups that include ACPA positive individuals without IA (At-Risk), ACPA negative individuals and individuals with early, ACPA positive clinical RA (Early RA). Differential methylation analysis among the groups identifies non-specific dysregulation in peripheral B, memory and naïve T cells in At-Risk participants, with more specific immunological pathway abnormalities in Early RA. Tetramer studies show increased abundance of T cells recognizing citrullinated (cit) epitopes in At-Risk participants, including expansion of T cells reactive to citrullinated cartilage intermediate layer protein I (cit-CILP); these T cells have Th1, Th17, and T stem cell memory-like phenotypes. Antibody-antigen array analyses show that antibodies targeting cit-clusterin, cit-fibrinogen and cit-histone H4 are elevated in At-Risk and Early RA participants, with the highest levels of antibodies detected in those with Early RA. These findings indicate that an ACPA positive at-risk state is associated with multifaceted immune dysregulation that may represent a potential opportunity for targeted intervention.
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Affiliation(s)
- Eddie A James
- Benaroya Research Institute, Seattle, WA, 98101, USA
| | - V Michael Holers
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - Radhika Iyer
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, 94304, USA
- VA Palo Alto Health Care System, Palo Alto, CA, 94550, USA
| | - E Barton Prideaux
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Navin L Rao
- Janssen Research and Development, Spring House, PA, 19477, USA
| | - Cliff Rims
- Benaroya Research Institute, Seattle, WA, 98101, USA
| | | | | | - Michelle S Bloom
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, 94304, USA
- VA Palo Alto Health Care System, Palo Alto, CA, 94550, USA
| | - Amin Zia
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, 94304, USA
- VA Palo Alto Health Care System, Palo Alto, CA, 94550, USA
| | - Serra E Elliott
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, 94304, USA
- VA Palo Alto Health Care System, Palo Alto, CA, 94550, USA
| | - Julia Z Adamska
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, 94304, USA
- VA Palo Alto Health Care System, Palo Alto, CA, 94550, USA
| | - Rizi Ai
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - R Camille Brewer
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, 94304, USA
- VA Palo Alto Health Care System, Palo Alto, CA, 94550, USA
| | - Jennifer A Seifert
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - LauraKay Moss
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Saman Barzideh
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - M Kristen Demoruelle
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Christopher C Striebich
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Yuko Okamoto
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Enkhtsogt Sainbayar
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Alexandra A Crook
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Ryan A Peterson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Lauren A Vanderlinden
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Wei Wang
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA, 92093, USA
- Department of Cellular and Molecular Medicine, University of California, San Diego, La Jolla, CA, 92093, USA
| | - David L Boyle
- Division of Rheumatology, Allergy and Immunology, University of California, San Diego, La Jolla, CA, 92093, USA
| | - William H Robinson
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, 94304, USA
- VA Palo Alto Health Care System, Palo Alto, CA, 94550, USA
| | | | - Gary S Firestein
- Division of Rheumatology, Allergy and Immunology, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Kevin D Deane
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
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Hughes-Austin JM, Katz R, Majka DS, Criqui MH, Robinson WH, Firestein GS, Hundley WG, Ix JH. Serum reactivity to citrullinated protein/peptide antigens and left ventricular structure and function in the Multi-Ethnic Study of Atherosclerosis (MESA). PLoS One 2023; 18:e0291967. [PMID: 37874814 PMCID: PMC10597499 DOI: 10.1371/journal.pone.0291967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 09/10/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Antibodies to citrullinated protein antigens have been linked to altered left ventricular (LV) structure and function in patients with rheumatoid arthritis (RA). Serum reactivity to several citrullinated protein/peptide antigens has been identified in RA, which are detectable years before RA onset and in individuals who may never develop RA. Among community-living individuals without heart failure (HF) at baseline in the Multi-Ethnic Study of Atherosclerosis (MESA), we investigated associations between serum reactivity to citrullinated protein/peptide antigens, LV mass, LV ejection fraction (LVEF), and incident HF. METHODS Among 1232 MESA participants, we measured serum reactivity to 28 different citrullinated proteins/peptides using a multiplex bead-based array. Each antibody was defined as having extremely high reactivity (EHR) if >95th percentile cut-off in MESA. Number of EHR antibody responses to citrullinated protein/peptide antigens were summed for each participant (range 0-28). LV mass(g) and LVEF(%) were measured on cardiac MRI. Associations between EHR antibodies and LV mass and LVEF were evaluated using linear regression. Cox proportional hazards models were used to evaluate associations between EHR antibodies and incident HF during 11 years of follow-up, adjusting for age, gender, race/ethnicity, smoking status, systolic blood pressure, use of anti-hypertensive medications, self-reported arthritis, IL-6, body surface area, and estimated glomerular filtration rate. RESULTS Mean age was 65±10, 50% were female, 40% were White, 21% were Black, 26% were Hispanic/Latino, and 14% were Chinese. Twenty-seven percent of MESA participants had extremely high reactivity to ≥ 1 citrullinated protein/peptide antigen. In fully adjusted analysis, every additional EHR antibody was significantly associated with 0.1% lower LVEF (95% CI: -0.17%, -0.02%). No association was observed with LV mass (β per additional EHR antibody) = 0.13±0.15 (p = 0.37)). Neither the presence nor number of EHR antibodies was associated with incident HF during follow-up (HR per additional EHR antibody = 1.008 (95% CI: 0.97, 1.05)). CONCLUSION Greater number of extremely highly reactive antibodies was associated with lower LVEF, but not with LV mass or incident HF. Thus, serum reactivity to citrullinated protein/peptide antigens was associated with subtle subclinical changes in myocardial contractility, but the significance in relation to clinically apparent HF is uncertain.
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Affiliation(s)
- Jan M. Hughes-Austin
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California, United States of America
| | - Ronit Katz
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, United States of America
| | - Darcy S. Majka
- Division of Rheumatology, DuPage Medical Group, Chicago, Illinois, United States of America
| | - Michael H. Criqui
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, United States of America
| | - William H. Robinson
- Division of Immunology and Rheumatology, Stanford University, Stanford, California, United States of America
- VA Palo Alto Health Care System, Palo Alto, California, United States of America
| | - Gary S. Firestein
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego, La Jolla, California, United States of America
| | - W. Gregory Hundley
- Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Joachim H. Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, La Jolla, California, United States of America
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Trier NH, Houen G. Anti-citrullinated protein antibodies as biomarkers in rheumatoid arthritis. Expert Rev Mol Diagn 2023; 23:895-911. [PMID: 37578277 DOI: 10.1080/14737159.2023.2247986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/15/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION The serological biomarker anti-citrullinated protein antibodies (ACPAs) may have several functions but is especially important for the diagnosis of rheumatoid arthritis (RA) along with clinical symptoms. AREAS COVERED This review provides an overview of ACPAs, which are useful in RA diagnostics and may improve our understanding of disease etiology. PubMed was searched with combinations of words related to antibodies recognizing epitopes containing the post-translationally modified amino acid citrulline in combination with rheumatoid arthritis; cyclic citrullinated peptide, CCP, anti-CCP, anti-citrullinated protein antibodies, ACPA, citrullination, peptide/protein arginine deiminase, PAD, filaggrin, vimentin, keratin, collagen, perinuclear factor, EBNA1, EBNA2, and others. From this search, we made a qualitative extract of publications relevant to the discovery, characterization, and clinical use of these antibodies in relation to RA. We highlight significant findings and identify areas for improvement. EXPERT OPINION ACPAs have high diagnostic sensitivity and specificity for RA and recognize citrullinated epitopes from several proteins. The best-performing single epitope originates from Epstein-Barr Virus nuclear antigen 2 and contains a central Cit-Gly motif, which is recognized by ACPAS when located in a flexible peptide structure. In addition, ACPAs may also have prognostic value, especially in relation to early treatment, although ACPAs' main function is to aid in the diagnosis of RA.
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Affiliation(s)
| | - Gunnar Houen
- Department of Neurology, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense M, Denmark
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Seifert JA, Bemis EA, Ramsden K, Lowell C, Polinski K, Feser M, Fleischer C, Demoruelle MK, Buckner J, Gregersen PK, Keating RM, Mikuls TR, O’Dell JR, Weisman MH, Deane KD, Norris JM, Steere AC, Holers VM. Association of Antibodies to Prevotella copri in Anti-Cyclic Citrullinated Peptide-Positive Individuals At Risk of Developing Rheumatoid Arthritis and in Patients With Early or Established Rheumatoid Arthritis. Arthritis Rheumatol 2023; 75:507-516. [PMID: 36259174 PMCID: PMC10065886 DOI: 10.1002/art.42370] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/20/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Prevotella copri (P copri), a gut commensal, has been reported to be an immune-relevant organism in individuals with rheumatoid arthritis (RA). This study sought to evaluate anti-P copri (anti-Pc) antibody responses in our participant cohorts and to determine when in the natural history of RA such responses develop. METHODS We analyzed serum levels of immunoglobulin A (IgA) and IgG antibodies from a 27-kd protein of P copri (anti-Pc-p27), an immunogenic P copri protein, in study participants at risk of developing RA, participants who transitioned to RA, participants with early RA (<1 year of disease), and participants with established RA, with comparisons made to their matched controls. We also evaluated anti-Pc-p27 antibody levels in individuals stratified by RA-related autoantibody status. RESULTS Overall, participants with RA had significantly higher IgA anti-Pc-p27 antibody levels and trended toward higher IgG anti-Pc-p27 antibody levels compared with matched controls. When stratified by early versus established RA, participants with early RA had median IgG anti-Pc-p27 antibody levels that were overall higher, whereas median IgA anti-Pc-p27 antibody levels were statistically significantly higher in participants with established RA compared with their matched controls. In the autoantibody-specific analyses, the at-risk population with anti-cyclic citrullinated peptide (anti-CCP) antibodies, but not rheumatoid factor (RF), trended toward increased levels of IgG anti-Pc-p27. Additionally, RA participants who were seropositive for both CCP and RF had significantly increased levels of IgA anti-Pc-p27 antibodies and trended toward higher levels of IgG anti-Pc-p27 antibodies compared with matched controls. CONCLUSION Our findings support a potential etiologic role for P copri in both RA preclinical evolution and the subsequent pathogenesis of synovitis.
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Affiliation(s)
| | | | - Kristina Ramsden
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Cassidy Lowell
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Marie Feser
- University of Colorado Denver, Aurora, Colorado
| | | | | | - Jane Buckner
- Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | - Peter K. Gregersen
- Feinstein Institutes for Medical Research and North Shore-Long Island Jewish Health System, Manhasset, New York
| | | | - Ted R. Mikuls
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Healthcare System, Omaha, Nebraska
| | - James R. O’Dell
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Healthcare System, Omaha, Nebraska
| | | | | | | | - Allen C. Steere
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Sieghart D, Konrad C, Swiniarski S, Haslacher H, Aletaha D, Steiner G. The diagnostic and prognostic value of IgG and IgA anti-citrullinated protein antibodies in patients with early rheumatoid arthritis. Front Immunol 2023; 13:1096866. [PMID: 36685579 PMCID: PMC9849943 DOI: 10.3389/fimmu.2022.1096866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023] Open
Abstract
Objectives Anti-citrullinated peptide antibodies (ACPA) are specific markers for rheumatoid arthritis (RA) and typically measured by assays employing a cyclic citrullinated peptide (CCP) as antigen. This study was aimed at investigating the diagnostic performance of anti-CCP2 and anti-CCP3 IgG and IgA assays in patients with early RA with a particular focus on the potential prognostic value of IgA ACPA. Methods The anti-CCP3.1 assay (Inova Diagnostics) measuring IgG and IgA antibodies simultaneously was compared to anti-CCP2 IgG and IgA assays (Thermo Fisher Scientific) employing sera of 184 early RA patients, 360 disease controls and 98 healthy subjects. Results Anti-CCP2 IgG and IgA assays showed high specificity versus disease controls (98.9%; 99.4%). Sensitivity was 52.2% (IgG) and 28.8% (IgA), resulting in positive likelihood ratios (LR+) of 47.5 (IgG) and 48.0 (IgA). The anti-CCP3.1 assay proved slightly more sensitive than the anti-CCP2 IgG assay (56%) but specificity was markedly lower (90.8% versus disease controls). However, when using a threefold higher cut-off specificity of the anti-CCP3.1 assay increased (97.5%) while sensitivity (52.7%) became comparable to the anti-CCP2 IgG assay resulting in a LR+ of 21.5. Anti-CCP2 IgA antibodies did not increase the diagnostic sensitivity of ACPA testing, but IgA positive patients showed diminished responses to treatment with anti-TNF biologicals compared to patients who had only IgG antibodies. Conclusion Specificity of ACPA assays should be adjusted to reduce the risk of misclassification and a false positive diagnosis. Determination of ACPA IgA might provide important prognostic information concerning therapeutic responses.
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Affiliation(s)
- Daniela Sieghart
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | | | | | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Günter Steiner
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria,*Correspondence: Günter Steiner,
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Bergstedt DT, Tarter WJ, Peterson RA, Feser ML, Parish MC, Striebich CC, Demoruelle MK, Moss L, Bemis EA, Norris JM, Holers VM, Edison JD, Thiele GM, Mikuls TR, Deane KD. Antibodies to Citrullinated Protein Antigens, Rheumatoid Factor Isotypes and the Shared Epitope and the Near-Term Development of Clinically-Apparent Rheumatoid Arthritis. Front Immunol 2022; 13:916277. [PMID: 35812446 PMCID: PMC9265214 DOI: 10.3389/fimmu.2022.916277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022] Open
Abstract
Background/Purpose In rheumatoid arthritis (RA) autoantibodies including antibodies to citrullinated protein antigens (ACPA) and rheumatoid factor (RF) can be predictive of incident clinical RA. However, there is limited understanding of how antibody changes over time impact prediction of the likelihood and timing of future clinical RA. Materials and Methods We evaluated relationships between ACPA, the shared epitope (SE), RF isotypes and incident RA in a prospective cohort of 90 ACPA(+) individuals without baseline arthritis identified through health-fair testing (i.e. Healthfair). We also evaluated ACPA and RF isotypes and time-to-diagnosis of RA in a retrospective cohort of 215 individuals with RA from the Department of Defense Serum Repository (DoDSR). Results Twenty-six of 90 (29%) of ACPA(+) Healthfair participants developed incident RA. Baseline or incident dual RF-IgA and RF-IgM positivity was associated with increased risk for incident RA (HR 3.09; 95% CI 1.15 to 8.29) although RFs were negative in ~50% of individuals with incident RA. SE was associated with increased risk of RA (HR 2.87, 95% CI 1.22-6.76). In the DoDSR cohort, triple positivity for ACPA, RF-IgA and RF-IgM was present a median of 1-2 years prior to RA diagnosis, with some sex-specific differences. Conclusion These findings can be used to counsel individuals at-risk for future RA and to design clinical trials for RA prevention. The findings also suggest that RF could be a surrogate outcome as a success of an immunologic intervention in RA prevention. Additional studies are needed to understand the biologic of different patterns of autoantibody elevations in RA evolution.
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Affiliation(s)
- Dylan T. Bergstedt
- Department of Medicine, St. Joseph’s Hospital, SCL Health, Denver, CO, United States
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Wyatt J. Tarter
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Ryan A. Peterson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Marie L. Feser
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Mark C. Parish
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Christopher C. Striebich
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - M. Kristen Demoruelle
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - LauraKay Moss
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Elizabeth A. Bemis
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Jill M. Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - V. Michael Holers
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Jess D. Edison
- Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Geoffrey M. Thiele
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States
| | - Ted R. Mikuls
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States
| | - Kevin D. Deane
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
- *Correspondence: Kevin D. Deane,
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Xie S, Li S, Chen B, Zhu Q, Xu L, Li F. Serum anti-citrullinated protein antibodies and rheumatoid factor increase the risk of rheumatoid arthritis-related interstitial lung disease: a meta-analysis. Clin Rheumatol 2021; 40:4533-4543. [PMID: 34189672 DOI: 10.1007/s10067-021-05808-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 05/04/2021] [Accepted: 06/01/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND This meta-analysis aims to determine the association between antibodies including anti-citrullinated protein antibodies (ACPA) and rheumatoid factors (RF) and risk of rheumatoid arthritis-related interstitial lung disease (RA-ILD). METHODS PubMed, Embase, and Cochrane were searched up to September 13, 2020, for studies investigating the risk of RA-ILD in ACPA-positive patients. The statistical meta-analysis and sensitivity analysis were performed using the Review Manager 5.4 and Stata16.0 software, respectively. RESULTS Total 1 double-blind randomized controlled study and 16 observational studies, including 992 RA-ILD patients and 2223 RA-non ILD patients, met the inclusion criteria of the meta-analysis. Compared with ACPA-negative patients, positive serum ACPA increased the risk of RA-ILD (OR = 2.51; 95% CI: 1.35-4.68; P = 0.004) and serum ACPA titer was significantly correlated with risk of RA-ILD (SMD = 0.39; 95% CI: 0.17-0.62; P = 0.0006). In a region-based subgroup analysis, ACPA titer in Asian, European, and African populations was significantly related to the risk of RA-ILD, while there was no significant correlation in the Americans (SMD = - 0.03; 95% CI: - 0.89-0.83; P = 0.95), especially in the USA (SMD = 0.37; 95% CI: - 0.26-0.99; P = 0.25). In addition, serum positive RF increased the risk of RA-ILD (OR = 2.85; 95% CI: 2.19-3.71; P < 0.00001) and serum RF titer was significantly correlated with the risk of RA-ILD (SMD = 0.35; 95% CI: 0.23-0.46; P < 0.00001). However, for the analysis of RF dichotomous data, the funnel shape was asymmetric and the p value of egger test was less than 0.05, which indicated potential publication bias. CONCLUSIONS ACPA and RF positive patients have greater risk of RA-ILD, and RA patients positive for ACPA should be paid more attention. KEY POINTS • Autoantibodies ACPA and RF increase the risk of RA-ILD. • Regions may be related to RA-ILD.
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Affiliation(s)
- Sisi Xie
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Shu Li
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Bilin Chen
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Qing Zhu
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Lichang Xu
- Department of Computer Science, University of California Santa Cruz, Santa Cruz, CA, 95064, USA
| | - Fen Li
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
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10
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Alghamdi MF, Redwan EM. Advances in the diagnosis of autoimmune diseases based on citrullinated peptides/proteins. Expert Rev Mol Diagn 2021; 21:685-702. [PMID: 34024239 DOI: 10.1080/14737159.2021.1933946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Autoimmune diseases are still one of the hard obstacles associated with humanity. There are many exogenous and endogenous etiological factors behind autoimmune diseases, which may be combined or dispersed to stimulate the autoimmune responses. Protein citrullination represents one of these factors. Harnessing specific citrullinated proteins/peptides could early predict and/or diagnose some of the autoimmune diseases. Many generations of diagnostic tools based on citrullinated peptides with comparable specificity/sensitivity are available worldwide.Areas covered: In this review, we discuss the deimination reaction behind the citrullination of most known autoantigens targeted, different generations of diagnostic tools based on citrullinated probes with specificity/sensitivity of each as well as newly developed assays. Furthermore, the most advanced molecular analytical tools to detect the citrullinated residues in the biological fluid and their performance are also evaluated, providing new avenues to early detect autoimmune diseases with high accuracy.Expert opinion: With the current specificity/sensitivity tools available for autoimmune disease detection, emphasis must be placed on developing more advance and effective, early, rapid, and simple diagnostic devices for autoimmune disease monitoring (similar to a portable device for sugar test at home). The molecular analytical devices with dual and/or multiplexe functions should be more simplified and invested in clinical laboratories.
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Affiliation(s)
- Mohammed F Alghamdi
- Biological Sciences Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia.,Laboratory Department, University Medical Services Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Elrashdy M Redwan
- Biological Sciences Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia.,Therapeutic and Protective Proteins Laboratory, Protein Research Department, Genetic Engineering and Biotechnology Research Institute, City for Scientific Research and Technology Applications, New Borg EL-Arab, Alexandria, Egypt
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11
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Mangalea MR, Paez-Espino D, Kieft K, Chatterjee A, Chriswell ME, Seifert JA, Feser ML, Demoruelle MK, Sakatos A, Anantharaman K, Deane KD, Kuhn KA, Holers VM, Duerkop BA. Individuals at risk for rheumatoid arthritis harbor differential intestinal bacteriophage communities with distinct metabolic potential. Cell Host Microbe 2021; 29:726-739.e5. [PMID: 33957082 PMCID: PMC8186507 DOI: 10.1016/j.chom.2021.03.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 02/08/2023]
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized in seropositive individuals by the presence of anti-cyclic citrullinated protein (CCP) antibodies. RA is linked to the intestinal microbiota, yet the association of microbes with CCP serology and their contribution to RA is unclear. We describe intestinal phage communities of individuals at risk for developing RA, with or without anti-CCP antibodies, whose first-degree relatives have been diagnosed with RA. We show that at-risk individuals harbor intestinal phage compositions that diverge based on CCP serology, are dominated by Streptococcaceae, Bacteroidaceae, and Lachnospiraceae phages, and may originate from disparate ecosystems. These phages encode unique repertoires of auxiliary metabolic genes, which associate with anti-CCP status, suggesting that these phages directly influence the metabolic and immunomodulatory capability of the microbiota. This work sets the stage for the use of phages as preclinical biomarkers and provides insight into a possible microbial-based causation of RA disease development.
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Affiliation(s)
- Mihnea R Mangalea
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | | | - Kristopher Kieft
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI 53715, USA
| | - Anushila Chatterjee
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Meagan E Chriswell
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Jennifer A Seifert
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Marie L Feser
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - M Kristen Demoruelle
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | | | - Karthik Anantharaman
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI 53715, USA
| | - Kevin D Deane
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Kristine A Kuhn
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - V Michael Holers
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Breck A Duerkop
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO 80045, USA.
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12
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Son JJ, Ishimori M, Mirocha J, Weisman MH, Forbess LJ. Low levels of anti-cyclic citrullinated peptide (CCP) 3.1 associated with diseases other than rheumatoid arthritis. Medicine (Baltimore) 2021; 100:e25558. [PMID: 33879708 PMCID: PMC8078438 DOI: 10.1097/md.0000000000025558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/29/2021] [Indexed: 01/04/2023] Open
Abstract
Our aim was to investigate the newest generation anti-cyclic citrullinated peptide (CCP) antibody 3.1 assay in diagnosing rheumatoid arthritis (RA) compared with other autoimmune and non-autoimmune diseases. We performed a retrospective observational chart review of patients with a positive CCP level over a one-year period at a single academic institution and assessed the associated diagnoses after at least six-months of follow-up. Of the 281 CCP positive patients during that period, 48% had a diagnosis of RA. The positive predictive value of RA in patients with a high CCP 3.1 assay was 0.619 compared to 0.248 with a low positive CCP 3.1 assay (P < .0001). Overall, there was a lower than expected positive predictive value of CCP 3.1 level with an RA diagnosis, though the likelihood of having an RA diagnosis was higher with a higher CCP level.
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Affiliation(s)
| | - Mariko Ishimori
- Cedars-Sinai Medical Center, Division of Rheumatology, Los Angeles, CA
| | - James Mirocha
- Cedars-Sinai Medical Center, Division of Rheumatology, Los Angeles, CA
| | | | - Lindsy J. Forbess
- Cedars-Sinai Medical Center, Division of Rheumatology, Los Angeles, CA
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13
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Morotti A, Sollaku I, Franceschini F, Cavazzana I, Fredi M, Sala E, De Palma G. Systematic Review and Meta-analysis on the Association of Occupational Exposure to Free Crystalline Silica and Rheumatoid Arthritis. Clin Rev Allergy Immunol 2021; 62:333-345. [PMID: 33651342 PMCID: PMC8994741 DOI: 10.1007/s12016-021-08846-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 01/01/2023]
Abstract
• Occupational exposure to free crystalline silica and tobacco smoking are associated with an increased risk rheumatoid arthritis, with the evidence of an interaction in seropositive subjects. • Further studies in the field are needed to support such association We carried out a systematic search for all published epidemiological studies concerning the association between occupational exposure to free crystalline silica (FCS) and subsequent development of rheumatoid arthritis (RA). A meta-analysis was conducted on relevant studies. We searched PubMed and Embase, search engines, for original articles published (from 1960 to November 2019) in any language. In addition, we also searched reference lists of included studies manually for additional relevant articles. Finally, twelve studies were included in the meta-analysis (seven case-control cases and five cohort studies). The odds risks and 95% confidence interval (CI) were calculated using a random effect meta-analysis. A primary meta-analysis (using a random effect model)—regarding RA risk in subjects exposed to FCS—yelled to an overall OR of 1.94 (95% CI 1.46–2.58). We also conducted three further meta-analysis, taking into account the presence of autoantibodies (anti-RF or anti-ACPA) and smoking habits and found a significant association between FCS and RA in both seropositive and seronegative subjects (OR 1.74, 95% CI 1.35–2.25 and OR 1.23, 95% CI 1.06–1.4, respectively) and in seropositive subjects which were smokers (OR 3.30, 95% CI 2.40–4.54). The studies that have investigated the association between RA and occupatational exposure to FCS are still scarce and the heterogeneity between the studies remains high. Some critical limitations have been identified within studies, among which, the methods for assessing exposure stand out. Although with due caution, our results confirm the hypothesis of an association between occupational exposure to FCS and RA development. There was an interaction between FCS and tobacco smoking in RA seropositive workers.
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Affiliation(s)
- A Morotti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Occupational Health and Industrial Hygiene, University of Brescia, Piazzale Spedali Civili 1, 25121, Brescia, Italy
| | - I Sollaku
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Occupational Health and Industrial Hygiene, University of Brescia, Piazzale Spedali Civili 1, 25121, Brescia, Italy
| | - F Franceschini
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy
- University Hospital "Spedali Civili Di Brescia," Rheumatology, Department of Clinical and Experimental Sciences (DSCS), University of Brescia, Brescia, Italy
| | - I Cavazzana
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy
| | - M Fredi
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy
- University Hospital "Spedali Civili Di Brescia," Rheumatology, Department of Clinical and Experimental Sciences (DSCS), University of Brescia, Brescia, Italy
| | - E Sala
- Unit of Occupational Health, Hygiene, Toxicology and Occupational Prevention, University Hospital "Spedali Civili Di Brescia,", Brescia, Italy
| | - G De Palma
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Occupational Health and Industrial Hygiene, University of Brescia, Piazzale Spedali Civili 1, 25121, Brescia, Italy.
- Unit of Occupational Health, Hygiene, Toxicology and Occupational Prevention, University Hospital "Spedali Civili Di Brescia,", Brescia, Italy.
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14
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Kolarz B, Ciesla M, Rosenthal AK, Dryglewska M, Majdan M. The value of anti-CarP and anti-PAD4 as markers of rheumatoid arthritis in ACPA/RF negative rheumatoid arthritis patients. Ther Adv Musculoskelet Dis 2021; 13:1759720X21989868. [PMID: 33628335 PMCID: PMC7882754 DOI: 10.1177/1759720x21989868] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/03/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Anti-citrullinated protein antibodies (ACPAs) and rheumatoid factor (RF) are key factors in the American College of Rheumatology/European League Against Rheumatism rheumatoid arthritis (RA) classification criteria markers. However, about 30% of patients diagnosed with RA are seronegative, rationalizing the need for new serologic markers for RA. Antibodies against carbamylated proteins (anti-CarP) and against peptidyl-arginine deiminase type 4 (anti-PAD4) have been postulated to be useful RA markers. The purpose of this study is to evaluate the value of anti-CarP and anti-PAD4 in a well-characterized population of RA patients and healthy controls (HCs). Methods: A total of 122 RA patients and 30 HCs were enrolled in the study. Serum levels of ACPA, anti-PAD4, anti-CarP and RF were determined by enzyme-linked immunosorbent immunoassays (ELISAs). Synthetic carbamylated peptides were used in the ELISA assay to determine the protein targets of the anti-CarP antibodies. Results: Rates of ACPA, RF, anti-PAD4 and anti-CarP positivity were 85.2%, 67.2%, 55.7% and 46.7% in RA, and 0%, 0%, 6.7% and 6.7% in HC respectively. In the RA population, 25.4% of patients had all four types of antibodies positive, while 6.6% had no antibodies. There was a significant correlation between anti-PAD4 and ACPAs (rs = 0.39), RF and ACPAs, (rs = 0.3) and RF and anti-CarP, (rs = 0.3). There was no correlation between ACPAs and anti-CarP. Anti-CarP positivity was noted in 49 (47.1%) and 45 (54.9%) of ACPAs and RF positive patients respectively. In addition, five anti-CarP+ patients did not have ACPA nor RF. Conclusion: Anti-CarP but not anti-PAD4 may be a useful biomarker in identifying ACPA/RF negative RA patients. This antibody may identify an additional RA population who may benefit from early implementation of aggressive therapy.
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Affiliation(s)
| | - Marek Ciesla
- Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
| | - Ann K. Rosenthal
- Division of Rheumatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Magdalena Dryglewska
- Department of Rheumatology and Connective Tissue Disease, Medical University of Lublin, Lublin, Lubelskie, Poland
| | - Maria Majdan
- Department of Rheumatology and Connective Tissue Disease, Medical University of Lublin, Lublin, Lubelskie, Poland
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15
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Deane KD, Holers VM. Rheumatoid Arthritis Pathogenesis, Prediction, and Prevention: An Emerging Paradigm Shift. Arthritis Rheumatol 2021; 73:181-193. [PMID: 32602263 PMCID: PMC7772259 DOI: 10.1002/art.41417] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022]
Abstract
Rheumatoid arthritis (RA) is currently diagnosed and treated when an individual presents with signs and symptoms of inflammatory arthritis (IA) as well as other features, such as autoantibodies and/or imaging findings, that provide sufficient confidence that the individual has RA-like IA (e.g., meeting established classification criteria) that warrants therapeutic intervention. However, it is now known that there is a stage of seropositive RA during which circulating biomarkers and other factors (e.g., joint symptoms) can be used to predict if and when an individual who does not currently have IA may develop future clinically apparent IA and classifiable RA. Indeed, the discovery of the "pre-RA" stage of seropositive disease has led to the development of several clinical trials in which individuals are studied to identify ways to delay or prevent the onset of clinically apparent IA/RA. This review focuses on several issues pertinent to understanding the prevention of RA. These include discussion of the pathogenesis of pre-RA development, prediction of the likelihood and timing of future classifiable RA, and a review of completed and ongoing clinical trials in RA prevention. Furthermore, this review discusses challenges and opportunities to be addressed to effect a paradigm shift in RA, where in the near future, proactive risk assessment focused on prevention of RA will become a public health strategy in much the same manner as cardiovascular disease is managed today.
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Affiliation(s)
- Kevin D. Deane
- Division of Rheumatology, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - V. Michael Holers
- Division of Rheumatology, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
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16
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Di Matteo A, Mankia K, Duquenne L, Mahler M, Corscadden D, Mbara K, Garcia‐Montoya L, Nam JL, Emery P. Third‐Generation Anti–Cyclic Citrullinated Peptide Antibodies Improve Prediction of Clinical Arthritis in Individuals at Risk of Rheumatoid Arthritis. Arthritis Rheumatol 2020; 72:1820-1828. [DOI: 10.1002/art.41402] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/15/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Andrea Di Matteo
- University of Leeds NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust, Leeds, UK, and Polytechnic University of Marche Carlo Urbani Hospital Jesi Italy
| | - Kulveer Mankia
- University of Leeds NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust Leeds UK
| | - Laurence Duquenne
- University of Leeds NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust Leeds UK
| | - Michael Mahler
- Inova Diagnostics, Inc. San Diego California United States
| | - Diane Corscadden
- University of Leeds NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust Leeds UK
| | - Katie Mbara
- University of Leeds NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust Leeds UK
| | - Leticia Garcia‐Montoya
- University of Leeds NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust Leeds UK
| | - Jacqueline L. Nam
- University of Leeds NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust Leeds UK
| | - Paul Emery
- University of Leeds NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust Leeds UK
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17
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Ford JA, Liu X, Marshall AA, Zaccardelli A, Prado MG, Wiyarand C, Lu B, Karlson EW, Schur PH, Deane KD, Sparks JA. Impact of Cyclic Citrullinated Peptide Antibody Level on Progression to Rheumatoid Arthritis in Clinically Tested Cyclic Citrullinated Peptide Antibody-Positive Patients Without Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2020; 71:1583-1592. [PMID: 30570827 DOI: 10.1002/acr.23820] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/11/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To investigate the risk of progression to rheumatoid arthritis (RA) in patients who were cyclic citrullinated peptide (CCP) antibody positive without RA at initial presentation. METHODS We performed a retrospective cohort study of CCP+ individuals seen at a US tertiary care system between 2009 and 2018 who were without RA or other systemic rheumatic disease by medical record review at the time of CCP antibody positivity. Progression to classifiable RA was determined through medical record review. We investigated the risk of progression to RA overall and stratified by CCP antibody level (low: >1 to 2× the upper limit of normal [ULN]; medium: >2 to 3× ULN; high: >3× ULN). Multivariable Cox regression estimated the hazard ratio (HR) and 95% confidence interval (95% CI) for RA by CCP antibody level. RESULTS We identified 340 CCP+ patients who were without RA or other rheumatic disease at baseline. During 1,047 person-years of follow-up, 73 patients (21.5%) developed RA. The risk of progression to RA increased with CCP antibody level, with 46.0% (95% CI 34.7-55.3) of patients with high-level CCP antibodies progressing to RA by 5 years. Compared to low CCP antibody level, medium (HR 3.00 [95% CI 1.32-6.81]) and high (HR 4.83 [95% CI 2.51-9.31]) CCP antibody levels were strongly associated with progression to RA, adjusting for age, sex, body mass index, smoking, family history of RA, and rheumatoid factor level. CONCLUSION Among CCP+ patients without RA, the risk for progression to RA increased substantially with increasing CCP antibody level. This study provides further support for close monitoring for development of RA among CCP+ patients and identifying strategies to mitigate this risk.
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Affiliation(s)
- Julia A Ford
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Xinyi Liu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Allison A Marshall
- Brigham and Women's Hospital, Harvard Medical School, and Tufts University School of Medicine, Boston, Massachusetts
| | | | - Maria G Prado
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charlene Wiyarand
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bing Lu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth W Karlson
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Peter H Schur
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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18
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Demoruelle MK, Wilson TM, Deane KD. Lung inflammation in the pathogenesis of rheumatoid arthritis. Immunol Rev 2020; 294:124-132. [DOI: 10.1111/imr.12842] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 12/21/2022]
Affiliation(s)
| | - Timothy M. Wilson
- Division of Rheumatology University of Colorado Denver Aurora CO USA
| | - Kevin D. Deane
- Division of Rheumatology University of Colorado Denver Aurora CO USA
- Denver Veterans Affairs Medical Center Denver CO USA
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19
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Finckh A, Courvoisier D, Lamacchia C. Measuring ACPA in the general population or primary care: is it useful? RMD Open 2020; 6:e001085. [PMID: 32079664 PMCID: PMC7046970 DOI: 10.1136/rmdopen-2019-001085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 01/13/2023] Open
Abstract
Rheumatoid arthritis (RA) is associated with a significant disease burden and high costs for society. Because the disease has identifiable preclinical stages, screening and prevention have become a possibility in RA. Anticitrullinated peptide antibodies (ACPAs) are arguably the most likely candidate biomarker to screen for RA. This paper reviews the evidence for the use of ACPAs as a screening test in the broader general population, to identify individuals at high risk of subsequent onset of RA. We will review the diagnostic properties of the test and its positive and negative predictive value in different settings. We will discuss how ACPA testing could effectively be integrated in a broader screening strategy for RA.
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Affiliation(s)
- Axel Finckh
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Celine Lamacchia
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
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20
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Kelmenson LB, Wagner BD, McNair BK, Frazer-Abel A, Demoruelle MK, Bergstedt DT, Feser ML, Moss LK, Parish MC, Mewshaw EA, Mikuls TR, Edison JD, Holers VM, Deane KD. Timing of Elevations of Autoantibody Isotypes Prior to Diagnosis of Rheumatoid Arthritis. Arthritis Rheumatol 2019; 72:251-261. [PMID: 31464042 DOI: 10.1002/art.41091] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/22/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate patterns of elevations of isotypes of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs) pre-rheumatoid arthritis (RA) diagnosis and post-RA diagnosis. METHODS Using the Department of Defense Serum Repository we identified 214 RA cases and 210 matched controls. Up to 3 pre-RA diagnosis and 1 post-RA diagnosis serum samples per subject were tested for RF and for IgA, IgG, and IgM ACPAs. The timing and trajectories of elevations of autoantibodies were evaluated. RESULTS Autoantibody levels were elevated in cases versus controls a mean of 17.9 years before RA diagnosis for IgG ACPA, 14.2 years for IgA-RF, 7.2 years for IgM-RF, 6.2 years for IgA ACPA, and 5.0 years for both IgM ACPA and IgG-RF (P < 0.01 for all comparisons). There were similar relationships for positive or negative autoantibody status, with cases first showing positivity for IgG ACPA 1.9 years pre-RA and for IgA-RF 1.7 years pre-RA, followed by the other isotypes. Only IgA ACPA positivity was significantly increased in post-RA diagnosis samples (19% 0-2 years pre-RA versus 39% >2 years post-RA diagnosis; P = 0.04). All autoantibody levels demonstrated an early initial elevation, a period of stability, then an increase immediately before RA diagnosis. A pre-RA endotype of early elevation of autoantibodies was associated with increased use of biologic therapy, and a higher prevalence of sicca symptoms and lung disease post-RA diagnosis. CONCLUSION Differences in patterns of elevations of autoantibody isotypes have implications for understanding the pathophysiology of RA development. These include understanding what factors drive initial autoantibody elevations compared to what factors (including mucosal) drive later increases in autoantibody levels and a transition to clinically apparent RA, and how pre-RA endotypes may influence post-RA diagnosis phenotypes.
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Affiliation(s)
| | | | | | | | | | | | - Marie L Feser
- University of Colorado Denver Anschutz Medical Campus
| | - Laura K Moss
- University of Colorado Denver Anschutz Medical Campus
| | - Mark C Parish
- University of Colorado Denver Anschutz Medical Campus
| | | | | | - Jess D Edison
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - Kevin D Deane
- University of Colorado Denver Anschutz Medical Campus
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21
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Solomon JJ, Matson S, Kelmenson LB, Chung JH, Hobbs SB, Rosas IO, Dellaripa PF, Doyle TJ, Poli S, Esposito AJ, Visser A, Marin AI, Amigues I, Fernández Pérez ER, Brown KK, Mahler M, Heinz D, Cool C, Deane KD, Swigris JJ, Demoruelle MK. IgA Antibodies Directed Against Citrullinated Protein Antigens Are Elevated in Patients With Idiopathic Pulmonary Fibrosis. Chest 2019; 157:1513-1521. [PMID: 31877269 DOI: 10.1016/j.chest.2019.12.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/23/2019] [Accepted: 12/09/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The etiology of idiopathic pulmonary fibrosis (IPF) is unknown. Because it shares genetic, histopathologic, and radiographic features with the fibrosing interstitial lung disease seen in rheumatoid arthritis (RA), the goal of this study was to investigate RA-related autoantibodies in IPF. METHODS The study included patients with IPF from two separate cohorts at National Jewish Health and Brigham Women's Hospital (n = 181), general population control subjects (n = 160), and control subjects with disease (n = 86 [40 with RA-usual interstitial pneumonia and 46 with hypersensitivity pneumonitis]). Serum was tested for RA-associated antibodies (including IgG and IgA) to citrullinated protein antigens (ACPA). Lung tissue in 11 patients with IPF was examined for ectopic lymphoid aggregates. RESULTS An increased prevalence of ACPA positivity was found in two separate IPF cohorts. In particular, positivity for IgA-ACPA was increased in these two IPF cohorts compared with general population control subjects (21.3% and 24.8% vs 5.6%; P < .01). Patients with IPF were more likely to be IgA-ACPA-positive than IgG-ACPA-positive (23.2% vs 8.3%; P < .01), whereas patients with RA were more likely to be IgG-ACPA-positive than IgA-ACPA-positive (72.5% vs 52.5%; P = .04). There was a strong correlation between IgA-ACPA level and the number of ectopic lymphoid aggregates on lung histologic examination in IPF (r = 0.72; P = .01). CONCLUSIONS In this study, IgA-ACPA was elevated in patients with IPF and correlated with lymphoid aggregates in the lung, supporting the theory that IgA-ACPA may play a role in lung disease pathogenesis in a subset of individuals with IPF. Future studies are needed to determine whether this subset of ACPA-positive patients with IPF is distinct from patients with IPF but without antibodies.
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Affiliation(s)
- Joshua J Solomon
- Interstitial Lung Disease Program & Autoimmune Lung Center, National Jewish Health, Denver, CO.
| | - Scott Matson
- Division of Pulmonary and Critical Care Medicine, University of Colorado Denver, Aurora, CO
| | | | | | - Stephen B Hobbs
- Department of Radiology, University of Kentucky, Lexington, KY
| | - Ivan O Rosas
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Paul F Dellaripa
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA
| | - Tracy J Doyle
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Sergio Poli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Anthony J Esposito
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ashley Visser
- Division of Rheumatology, University of Colorado Denver, Aurora, CO
| | - A Itzam Marin
- Division of Rheumatology, University of Colorado Denver, Aurora, CO
| | | | - Evans R Fernández Pérez
- Interstitial Lung Disease Program & Autoimmune Lung Center, National Jewish Health, Denver, CO
| | - Kevin K Brown
- Interstitial Lung Disease Program & Autoimmune Lung Center, National Jewish Health, Denver, CO
| | | | - David Heinz
- Department of Pathology, National Jewish Health, Denver, CO
| | - Carlyne Cool
- Department of Pathology, National Jewish Health, Denver, CO; Department of Pathology, University of Colorado Denver, Aurora, CO
| | - Kevin D Deane
- Division of Rheumatology, University of Colorado Denver, Aurora, CO
| | - Jeffrey J Swigris
- Interstitial Lung Disease Program & Autoimmune Lung Center, National Jewish Health, Denver, CO
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22
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Volkov M, van Schie KA, van der Woude D. Autoantibodies and B Cells: The ABC of rheumatoid arthritis pathophysiology. Immunol Rev 2019; 294:148-163. [PMID: 31845355 PMCID: PMC7065213 DOI: 10.1111/imr.12829] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 11/07/2019] [Indexed: 12/16/2022]
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by joint inflammation. In the last few decades, new insights into RA‐specific autoantibodies and B cells have greatly expanded our understanding of the disease. The best‐known autoantibodies in RA—rheumatoid factor (RF) and anti‐citrullinated protein antibodies (ACPA)—are present long before disease onset, and both responses show signs of maturation around the time of the first manifestation of arthritis. A very intriguing characteristic of ACPA is their remarkably high abundance of variable domain glycans. Since these glycans may convey an important selection advantage of citrulline‐reactive B cells, they may be the key to understanding the evolution of the autoimmune response. Recently discovered autoantibodies targeting other posttranslational modifications, such as anti‐carbamylated and anti‐acetylated protein antibodies, appear to be closely related to ACPA, which makes it possible to unite them under the term of anti‐modified protein antibodies (AMPA). Despite the many insights gained about these autoantibodies, it is unclear whether they are pathogenic or play a causal role in disease development. Autoreactive B cells from which the autoantibodies originate have also received attention as perhaps more likely disease culprits. The development of autoreactive B cells in RA largely depends on the interaction with T cells in which HLA “shared epitope” and HLA DERAA may play an important role. Recent technological advances made it possible to identify and characterize citrulline‐reactive B cells and acquire ACPA monoclonal antibodies, which are providing valuable insights and help to understand the nature of the autoimmune response underlying RA. In this review, we summarize what is currently known about the role of autoantibodies and autoreactive B cells in RA and we discuss the most prominent hypotheses aiming to explain the origins and the evolution of autoimmunity in RA.
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Affiliation(s)
- Mikhail Volkov
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karin Anna van Schie
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Diane van der Woude
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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23
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Deane KD, Demoruelle MK. Drs. Deane and Demoruelle reply. J Rheumatol 2019; 47:300. [PMID: 31787609 DOI: 10.3899/jrheum.191060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - M Kristen Demoruelle
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
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24
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Tanner S, Dufault B, Smolik I, Meng X, Anaparti V, Hitchon C, Robinson DB, Robinson W, Sokolove J, Lahey L, Ferucci ED, El-Gabalawy H. A Prospective Study of the Development of Inflammatory Arthritis in the Family Members of Indigenous North American People With Rheumatoid Arthritis. Arthritis Rheumatol 2019; 71:1494-1503. [PMID: 30861615 DOI: 10.1002/art.40880] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 03/05/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the incidence of inflammatory arthritis and autoantibody prevalence in Indigenous North American people. METHODS Unaffected relatives of Indigenous North Americans with rheumatoid arthritis (RA) from central Canada and Alaska were systematically monitored from 2005 to 2017. Rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs) were tested at every visit, and a subset was tested for ACPA fine specificity using a custom multiplex assay. Multistate models based on all available study visits were developed to determine the likelihood of transitioning between autoantibody states, or to inflammatory arthritis. RESULTS Eighteen of 374 relatives (4.8%) developed inflammatory arthritis during follow-up (after a mean ± SD of 4.7 ± 2.4 years), yielding a transition rate of 9.2 cases/1,000 person-years. Thirty percent of those who developed inflammatory arthritis were seronegative at baseline, but all were seropositive at inflammatory arthritis onset. Although 30% of ACPA/RF double-seropositive individuals developed inflammatory arthritis (after 3.2 ± 2.2 years), the majority of these individuals did not develop inflammatory arthritis. Multistate modeling indicated a 71% and 68% likelihood of ACPA and RF seropositive states, respectively, reverting to a seronegative state after 5 years, and a 39% likelihood of an ACPA/RF double-seropositive state becoming seronegative. Fine specificity testing demonstrated an expansion of the ACPA repertoire prior to the development of inflammatory arthritis. CONCLUSION Despite a high incidence of inflammatory arthritis in this cohort of at-risk relatives of Indigenous North Americans with RA, a large proportion of autoantibody-positive individuals do not develop inflammatory arthritis and revert back to an autoantibody-negative state.
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Affiliation(s)
- Stacy Tanner
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brenden Dufault
- George and Fay Yee Centre for Healthcare Innovation and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Irene Smolik
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Xiaobo Meng
- University of Manitoba, Winnipeg, Manitoba, Canada
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25
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Terasaki Y, Terasaki M, Kanazawa S, Kokuho N, Urushiyama H, Kajimoto Y, Kunugi S, Maruyama M, Akimoto T, Miura Y, Igarashi T, Ohsawa I, Shimizu A. Effect of H 2 treatment in a mouse model of rheumatoid arthritis-associated interstitial lung disease. J Cell Mol Med 2019; 23:7043-7053. [PMID: 31424157 PMCID: PMC6787460 DOI: 10.1111/jcmm.14603] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 12/21/2022] Open
Abstract
Rheumatoid arthritis (RA)-associated interstitial lung disease (ILD), a primary cause of mortality in patients with RA, has limited treatment options. A previously established RA model in D1CC transgenic mice aberrantly expressed major histocompatibility complex class II genes in joints, developing collagen II-induced polyarthritis and anti-cyclic citrullinated peptide antibodies and interstitial pneumonitis, similar to those in humans. Molecular hydrogen (H2 ) is an efficient antioxidant that permeates cell membranes and alleviates the reactive oxygen species-induced injury implicated in RA pathogenesis. We used D1CC mice to analyse chronic lung fibrosis development and evaluate H2 treatment effects. We injected D1CC mice with type II collagen and supplied them with H2 -rich or control water until analysis. Increased serum surfactant protein D values and lung densities images were observed 10 months after injection. Inflammation was patchy within the perilymphatic stromal area, with increased 8-hydroxy-2'-deoxyguanosine-positive cell numbers and tumour necrosis factor-α, BAX, transforming growth factor-β, interleukin-6 and soluble collagen levels in the lungs. Inflammatory and fibrotic changes developed diffusely within the perilymphatic stromal area, as observed in humans. H2 treatment decreased these effects in the lungs. Thus, this model is valuable for studying the effects of H2 treatment and chronic interstitial pneumonia pathophysiology in humans. H2 appears to protect against RA-ILD by alleviating oxidative stress.
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Affiliation(s)
- Yasuhiro Terasaki
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Mika Terasaki
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Satoshi Kanazawa
- Department of Molecular and Cellular Biology, Nagoya City University, Nagoya, Japan
| | - Nariaki Kokuho
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Hirokazu Urushiyama
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yusuke Kajimoto
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shinobu Kunugi
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Motoyo Maruyama
- Division of Laboratory Animal Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Toshio Akimoto
- Division of Laboratory Animal Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoko Miura
- Department of Molecular and Cellular Biology, Nagoya City University, Nagoya, Japan
| | - Tsutomu Igarashi
- Department of Ophthalmology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Ikuroh Ohsawa
- Biological Process of Aging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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26
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Bemis EA, Norris JM, Seifert J, Frazer-Abel A, Okamoto Y, Feser ML, Demoruelle MK, Deane KD, Banda NK, Holers VM. Complement and its environmental determinants in the progression of human rheumatoid arthritis. Mol Immunol 2019; 112:256-265. [PMID: 31207549 PMCID: PMC7712508 DOI: 10.1016/j.molimm.2019.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/26/2019] [Accepted: 05/29/2019] [Indexed: 12/28/2022]
Abstract
Rheumatoid arthritis (RA) is a complex autoimmune disease with an etiology that is not yet well understood, disproportionally affects women and also varies in incidence and prevalence by population. The presence of anti-citrullinated protein antibodies (ACPA) is a highly specific biomarker for the diagnosis of clinically apparent RA. ACPA are also present in the serum for an average of 3-5 years prior to the onset of RA during an asymptomatic period characterized by mucosal inflammation and local ACPA production at these sites. We hypothesized that systemic complement activation products might be generated during the pre-clinical initiation of RA and/or provide a second hit that promotes subsequent arthritis development in the joints. In addition, we evaluated which demographic and genetic features and environmental exposures could influence the complement activation process. We analyzed plasma from healthy subjects, subjects at-risk for the development of RA based on serum ACPA positivity in absence of inflammatory arthritis (IA), and ACPA positive RA subjects by Multiplex Assay and ELISA for eighteen complement system components, factors and activation products belonging to the classical, lectin and alternative pathways. By using regression models, associations between complement proteins and various demographic, genetic, and environmental factors previously found to be associated with RA, including sex, smoking, shared epitope, and oral contraceptive use, were examined. We found no evidence of systemic complement activation in ACPA positive subjects without IA, but in contrast found evidence of systemic involvement of the both classical and alternative pathways during the stage of the disease where classified RA is present, (i.e. during joint inflammation and damage). With regard to the demographic, genetic, and environmental variables, females who reported current or past oral contraceptive use and subjects with current tobacco exposure demonstrated alterations of the alternative pathway of complement. Furthermore, RA subjects with established disease who have a body mass index categorized as obese demonstrated higher levels of C2 compared to RA subjects who are not considered obese. In sum, the complement system may be involved in the pathogenesis of RA, with only localized mucosal effects during the preclinical period in those at-risk for RA but in the joint as well as systemically in those who have developed clinically apparent arthritis.
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Affiliation(s)
- Elizabeth A Bemis
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Jennifer Seifert
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Ashley Frazer-Abel
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Yuko Okamoto
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Marie L Feser
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - M Kristen Demoruelle
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Kevin D Deane
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Nirmal K Banda
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States.
| | - V Michael Holers
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
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27
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Deane KD, Holers VM. The Natural History of Rheumatoid Arthritis. Clin Ther 2019; 41:1256-1269. [PMID: 31196652 DOI: 10.1016/j.clinthera.2019.04.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE This article reviews the phases of rheumatoid arthritis (RA) development in terms of the evolution of disease, with a focus on events that occur before the first appearance of clinically apparent inflammatory arthritis. This presynovitis period is defined in individuals who eventually develop classified RA as the pre-RA phase. We include additional discussion of the relevance of this model of RA development to the concept of disease prevention. METHODS The information provided in this review was identified through searches of the medical literature through MEDLINE and a review of references from published manuscripts as well as information obtained by the authors through attendance at various conferences and working groups related to pre-RA. FINDINGS It is now well established that RA develops in a series of phases. The first of these phases is believed to be the presence of genetic and/or environmental risk factors for RA in the absence of detectable systemic autoimmunity in the blood. After this phase, autoimmunity may be detectable through a variety of means (eg, autoantibodies, autoreactive cells) in peripheral blood; in addition, there is emerging evidence that perhaps initiation and early propagation of RA-related autoimmunity may occur at mucosal sites. The presence of autoimmunity detectable in the blood through serologic or other testing is followed in most individuals by a propagation phase that is characterized by an expansion of autoimmunity, inflammation, and symptoms. This transition may be associated with similar or different genetic and environmental factors that initially triggered autoimmunity, as well as continued mucosal inflammation and local RA-related autoantibody production. Eventually, clinically detectable inflammatory arthritis develops that can be classified as RA. IMPLICATIONS Understanding the phases of RA development are critical to the development of preventive strategies for this disease.
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Affiliation(s)
- Kevin D Deane
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.
| | - V Michael Holers
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
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28
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Bednar KJ, Nycholat CM, Rao TS, Paulson JC, Fung-Leung WP, Macauley MS. Exploiting CD22 To Selectively Tolerize Autoantibody Producing B-Cells in Rheumatoid Arthritis. ACS Chem Biol 2019; 14:644-654. [PMID: 30835424 DOI: 10.1021/acschembio.8b01018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease that primarily affects the synovial joints and can lead to bone erosion and cartilage damage. One hallmark of RA is anticitrullinated protein autoantibodies (ACPA) and memory citrulline-specific B-cells, which have been implicated in RA pathogenesis. While depletion of B-cells with Rituximab improves clinical responses in RA patients, this treatment strategy leaves patients susceptible to infections. Here we use of Siglec-engaging Tolerance-inducing Antigenic Liposomes (STALs) to selectively target the citrulline-specific B-cells. ACPA production from purified human RA patients' B-cells in vitro was achieved through a set of stimulation conditions, which includes the following: BAFF, anti-CD40, IL-21, and LPS. In vivo generation of citrulline specific B-cells and ACPA production was accomplished by antigenic liposomes consisting of monophosphoryl lipid A (MPLA) and a cyclic citrullinated peptide (CCP) administered to SJL/J mice. We show that STALs that codisplay a high affinity CD22 glycan ligand and synthetic citrullinated antigen (CCP STALs) can prevent ACPA production from RA patients' memory B-cells in vitro. These CCP STALs were also effective in inducing tolerance to citrullinated antigens in SJL/J mice. The results demonstrate that tolerization of the B-cells responsible for ACPA can be achieved by exploiting the inhibitory receptor CD22 with high-affinity glycan ligands. Such a treatment strategy could be beneficial in the treatment of RA.
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Affiliation(s)
- Kyle J. Bednar
- Discovery Immunology, Janssen Pharmaceutical Research and Development, LLC, 3210 Merryfield Road, San Diego, California 92121, United States
- Department of Molecular Medicine, The Scripps Research Institute, North Torrey Pines Road, La Jolla, California 92037, United States
| | - Corwin M. Nycholat
- Department of Immunology and Microbial Sciences, The Scripps Research Institute, North Torrey Pines Road, La Jolla, California 92037, United States
| | - Tadimeti S. Rao
- Discovery Immunology, Janssen Pharmaceutical Research and Development, LLC, 3210 Merryfield Road, San Diego, California 92121, United States
| | - James C. Paulson
- Department of Molecular Medicine, The Scripps Research Institute, North Torrey Pines Road, La Jolla, California 92037, United States
- Department of Immunology and Microbial Sciences, The Scripps Research Institute, North Torrey Pines Road, La Jolla, California 92037, United States
| | - Wai-Ping Fung-Leung
- Discovery Immunology, Janssen Pharmaceutical Research and Development, LLC, 3210 Merryfield Road, San Diego, California 92121, United States
| | - Matthew S. Macauley
- Department of Molecular Medicine, The Scripps Research Institute, North Torrey Pines Road, La Jolla, California 92037, United States
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29
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Berens HM, Polinski KJ, Mikuls TR, Khatter S, August J, Visser A, Mahler M, Weisman MH, O'Dell JR, Keating RM, Buckner JH, Gregersen PK, Norris JM, Holers VM, Deane KD, Demoruelle MK. Anticyclic Citrullinated Peptide Antibodies 3.1 and Anti-CCP-IgA Are Associated with Increasing Age in Individuals Without Rheumatoid Arthritis. J Rheumatol 2019; 46:1556-1559. [PMID: 30988128 DOI: 10.3899/jrheum.180897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We investigated the association of age and anticyclic citrullinated peptide antibodies (anti-CCP) in subjects without rheumatoid arthritis (RA). METHODS Serum was tested for anti-CCP3.1 (IgG/IgA) in 678 first-degree relatives (FDR) of patients with RA and 330 patients with osteoarthritis (OA). Individual isotypes (anti-CCP-IgA and anti-CCP-IgG) were also tested in all FDR. RESULTS In FDR, increasing age was significantly associated with positivity for anti-CCP3.1 (per year, OR 1.03) and anti-CCP-IgA (per year, OR 1.05) but not anti-CCP-IgG. In FDR and OA subjects, anti-CCP3.1 prevalence was significantly increased after age 50 years. CONCLUSION Increasing age in individuals without RA should be considered in the interpretation of anti-CCP3.1 positivity.
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Affiliation(s)
- Heather M Berens
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Kristen J Polinski
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Ted R Mikuls
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Sonia Khatter
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Justin August
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Ashley Visser
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Michael Mahler
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Michael H Weisman
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - James R O'Dell
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Richard M Keating
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Jane H Buckner
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Peter K Gregersen
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Jill M Norris
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - V Michael Holers
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Kevin D Deane
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - M Kristen Demoruelle
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA. .,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus.
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James JA, Chen H, Young KA, Bemis EA, Seifert J, Bourn RL, Deane KD, Demoruelle MK, Feser M, O'Dell JR, Weisman MH, Keating RM, Gaffney PM, Kelly JA, Langefeld CD, Harley JB, Robinson W, Hafler DA, O'Connor KC, Buckner J, Guthridge JM, Norris JM, Holers VM. Latent autoimmunity across disease-specific boundaries in at-risk first-degree relatives of SLE and RA patients. EBioMedicine 2019; 42:76-85. [PMID: 30952617 PMCID: PMC6491794 DOI: 10.1016/j.ebiom.2019.03.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/15/2019] [Accepted: 03/21/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Autoimmune disease prevention requires tools to assess an individual's risk of developing a specific disease. One tool is disease-associated autoantibodies, which accumulate in an asymptomatic preclinical period. However, patients sometimes exhibit autoantibodies associated with a different disease classification. When and how these alternative autoantibodies first appear remain unknown. This cross-sectional study characterizes alternative autoimmunity, and associated genetic and environmental factors, in unaffected first-degree relatives (FDRs) of patients, who exhibit increased future risk for the same disease. METHODS Samples (n = 1321) from disease-specific autoantibody-positive (aAb+) systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and type 1 diabetes (T1D) patients; and unaffected aAb+ and autoantibody-negative (aAb-) SLE and RA FDRs were tested for SLE, RA, and T1D aAbs, as well as anti-tissue transglutaminase, anti-cardiolipin and anti-thyroperoxidase. FDR SLE and RA genetic risk scores (GRS) were calculated. FINDINGS Alternative autoimmunity occurred in SLE patients (56%) and FDRs (57·4%), RA patients (32·6%) and FDRs (34·8%), and T1D patients (43%). Expanded autoimmunity, defined as autoantibodies spanning at least two other diseases, occurred in 18·5% of SLE patients, 16·4% of SLE FDRs, 7·8% of RA patients, 5·3% of RA FDRs, and 10·8% of T1D patients. SLE FDRs were more likely to have alternative (odds ratio [OR] 2·44) and expanded (OR 3·27) autoimmunity than RA FDRs. Alternative and expanded autoimmunity were associated with several environmental exposures. Alternative autoimmunity was associated with a higher RA GRS in RA FDRs (OR 1·41), and a higher SLE GRS in aAb+ RA FDRs (OR 1·87), but not in SLE FDRs. INTERPRETATION Autoimmunity commonly crosses disease-specific boundaries in systemic (RA, SLE) and organ-specific (T1D) autoimmune diseases. Alternative autoimmunity is more common in SLE FDRs than RA FDRs, and is influenced by genetic and environmental factors. These findings have substantial implications for preclinical disease pathogenesis and autoimmune disease prevention studies. FUND: NIH U01AI101981, R01AR051394, U19AI082714, P30AR053483, P30GM103510, U54GM104938, U01AI101934, R01AI024717, U01AI130830, I01BX001834, & U01HG008666.
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Affiliation(s)
- Judith A James
- Oklahoma Medical Research Foundation, Oklahoma City, OK, USA; University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Hua Chen
- Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | | | | | | | - Rebecka L Bourn
- Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | | | | | | | | | | | | | | | | | | | - John B Harley
- Cincinnati Children's Hospital Medical Center, The University of Cincinnati College of Medicine, and Cincinnati US Department of Veterans Affairs VA Medical Center, Cincinnati, OH, USA
| | | | | | | | - Jane Buckner
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
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Giacomelli R, Afeltra A, Alunno A, Bartoloni-Bocci E, Berardicurti O, Bombardieri M, Bortoluzzi A, Caporali R, Caso F, Cervera R, Chimenti MS, Cipriani P, Coloma E, Conti F, D'Angelo S, De Vita S, Di Bartolomeo S, Distler O, Doria A, Feist E, Fisher BA, Gerosa M, Gilio M, Guggino G, Liakouli V, Margiotta DPE, Meroni P, Moroncini G, Perosa F, Prete M, Priori R, Rebuffi C, Ruscitti P, Scarpa R, Shoenfeld Y, Todoerti M, Ursini F, Valesini G, Vettori S, Vitali C, Tzioufas AG. Guidelines for biomarkers in autoimmune rheumatic diseases - evidence based analysis. Autoimmun Rev 2019; 18:93-106. [PMID: 30408582 DOI: 10.1016/j.autrev.2018.08.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/11/2018] [Indexed: 12/21/2022]
Abstract
Autoimmune rheumatic diseases are characterised by an abnormal immune system response, complement activation, cytokines dysregulation and inflammation. In last years, despite many progresses in managing these patients, it has been shown that clinical remission is reached in less than 50% of patients and a personalised and tailored therapeutic approach is still lacking resulting in a significant gap between guidelines and real-world practice. In this context, the need for biomarkers facilitating early diagnosis and profiling those individuals at the highest risk for a poor outcome has become of crucial interest. A biomarker generally refers to a measured characteristic which may be used as an indicator of some biological state or condition. Three different types of medical biomarkers has been suggested: i. mechanistic markers; ii. clinical disease markers; iii. therapeutic markers. A combination of biomarkers from these different groups could be used for an ideal more accurate diagnosis and treatment. However, although a growing body of evidence is focused on improving biomarkers, a significant amount of this information is not integrated on standard clinical care. The overarching aim of this work was to clarify the meaning of specific biomarkers during autoimmune diseases; their possible role in confirming diagnosis, predicting outcome and suggesting specific treatments.
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Affiliation(s)
- Roberto Giacomelli
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy.
| | - Antonella Afeltra
- Department of Medicine, Unit of Allergology, Immunology, Rheumatology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Onorina Berardicurti
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Alessandra Bortoluzzi
- Department of Medical Science, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero-Universitaria S.Anna, Cona, Ferrara, Italy
| | - Roberto Caporali
- IRCCS Policlinico San Matteo Foundation, Division of Rheumatology, University of Pavia, Pavia, Italy
| | - Francesco Caso
- Department of Clinical Medicine and Surgery, Rheumatology Unit, University of Naples Federico II, Naples, Italy
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Maria Sole Chimenti
- Department of Medicina dei Sistemi, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Paola Cipriani
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Emmanuel Coloma
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Fabrizio Conti
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Salvatore D'Angelo
- PhD Scholarship in Life Sciences, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Salvatore De Vita
- Department of Medical and Biological Sciences, Rheumatology Clinic, Azienda Ospedaliero Universitaria S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Salvatore Di Bartolomeo
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, DIMED, University of Padua, Padua, Italy
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology of the Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin A Fisher
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK; Department of Rheumatology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Maria Gerosa
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Michele Gilio
- PhD Scholarship in Life Sciences, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Giuliana Guggino
- Dipartimento Biomedico di Medicina Interna e Specialistica, Rheumatology section, University of Palermo, Italy
| | - Vasiliki Liakouli
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Domenico Paolo Emanuele Margiotta
- Department of Medicine, Unit of Allergology, Immunology, Rheumatology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Pierluigi Meroni
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Gianluca Moroncini
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Federico Perosa
- Department of Biomedical Sciences and Human Oncology (DIMO), Systemic Rheumatic and Autoimmune Diseases Unit, University of Bari Medical School, Bari, Italy
| | - Marcella Prete
- Department of Biomedical Sciences and Human Oncology (DIMO), Systemic Rheumatic and Autoimmune Diseases Unit, University of Bari Medical School, Bari, Italy
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Chiara Rebuffi
- Grant Office and Scientific Documentation Center, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Piero Ruscitti
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Raffaele Scarpa
- Department of Clinical Medicine and Surgery, Rheumatology Unit, University of Naples Federico II, Naples, Italy
| | - Yehuda Shoenfeld
- Zabludowitz Centre for Autoimmune Diseases, Sheba Medical Centre, Tel-Hashomer, Israel
| | - Monica Todoerti
- IRCCS Policlinico San Matteo Foundation, Division of Rheumatology, University of Pavia, Pavia, Italy
| | - Francesco Ursini
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Guido Valesini
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Serena Vettori
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Athanasios G Tzioufas
- Pathophysiology Department, General Hospital of Athens "Laiko", Medical School, National and Kapodistrian University of Athens, Greece
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Diagnostic Value of Anti-Fibrinogen Citrullinated Peptide in Rheumatoid Arthritis. ACTA ACUST UNITED AC 2018; 16:455-461. [PMID: 30594439 DOI: 10.1016/j.reuma.2018.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/18/2018] [Accepted: 11/06/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determinate the diagnostic value of an antibody against a citrullinated fibrinogen peptide in Cuban patients with rheumatoid arthritis, using an enzyme immunasay. MATERIALS AND METHODS A citrullinated peptide of fibrinogen designed by informatics prediction was synthesized and used in an enzyme immunoassay. The participants were 81 patients with early disease, 81 patients with established disease, 58 patients with other rheumatic and inflammatory diseases, and 43 healthy individuals. Anti- citrullinated fibrinogen peptide, anti-mutated citrullinated vimentin, anti second generation citrullinated peptides and rheumatoid factor antibodies were determined by enzyme-linked immunosorbent assay. RESULTS Determination of anti-citrullinated peptide of fibrinogen antibodies by the designed enzyme immunoassay showed the best diagnostic value in early rheumatoid arthritis patients, with the highest value sensitivity (84%), negative predictive value (85%), Youden index (0.73%) and area under the receiver operating curve (0.9192). Specificity (89%) and positive predictive value (88%) were higher than rheumatoid factor, similar to anti- mutated citrullinated vimentin, but lower than second generation anti-citrullinated peptides assay. The positivity of C-reactive protein was associated with the presence of anti- citrullinated fibrinogen peptide antibodies and the titres of these antibodies correlated with clinical activity in early disease. CONCLUSIONS The immunoassay designed with a citrullinated fibrinogen peptide has a high diagnostic value and can identify patients with greater clinical activity in early rheumatoid arthritis.
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Abstract
PURPOSE OF REVIEW This review is to provide an update on the current understanding of rheumatoid arthritis (RA) development related to disease development prior to the onset clinically apparent synovitis and opportunities for disease prevention. RECENT FINDINGS A growing number of studies have demonstrated that serum elevations of autoantibodies rheumatoid factor and antibodies to citrullinated protein/peptide antigens (ACPA) are highly predictive of future development of IA/RA. This has underpinned the development of several prevention trials in RA. The full results from most of these prevention trials are pending, but ultimately, they should further inform several critical issues in RA prevention including identification and enrollment of individuals at high risk of imminent RA, the efficacy, safety and cost-effectiveness of prevention, and potentially the identification of new targets for prevention. Results from studies in RA prevention as well as other ongoing natural history studies of RA will help to change the paradigm of how RA is managed, potentially adding prevention to the possibilities for management.
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Affiliation(s)
- Kevin D Deane
- Division of Rheumatology, University of Colorado School of Medicine, 1775 Aurora Court, Mail Stop B-115, Aurora, CO, 80045, USA.
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Lingampalli N, Sokolove J, Lahey LJ, Edison JD, Gilliland WR, Holers VM, Deane KD, Robinson WH. Combination of anti-citrullinated protein antibodies and rheumatoid factor is associated with increased systemic inflammatory mediators and more rapid progression from preclinical to clinical rheumatoid arthritis. Clin Immunol 2018; 195:119-126. [PMID: 29842946 DOI: 10.1016/j.clim.2018.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 12/26/2022]
Abstract
The development of rheumatoid factor (RF) and/or anti-citrullinated protein antibodies (ACPAs) can be observed years prior to clinical diagnosis of rheumatoid arthritis (RA). Nevertheless, the interaction between these two autoantibodies and their combined effect on development of RA is unclear. We measured RF, cytokines, and ACPA subtypes in serial pre-clinical serum samples collected from 83 US veterans who all developed RA. Levels of cytokines and ACPAs were compared between the following groups: anti-cyclic citrullinated peptide (anti-CCP)-/RF- (double negative), anti-CCP+/RF-, anti-CCP-/RF+, or anti-CCP+/RF+ (double-positive). The double-positive subgroup had significantly higher levels of 20 inflammatory cytokines and 29 ACPA reactivities, and the shortest interval, 1.3 years, between the preclinical sample timepoint and diagnosis of RA. Thus, the combined presence of ACPAs and RF is associated with a more rapid progression to RA, suggesting that anti-CCP+/RF+ individuals have a more advanced preclinical disease state and that the onset of RA may be imminent.
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Affiliation(s)
- Nithya Lingampalli
- VA Palo Alto Health Care System, 3801 Miranda Ave, C4-191, Palo Alto, CA 94304, United States; Division of Immunology and Rheumatology, Stanford University, 269 Campus Drive, CCSR 4135, Stanford, CA 94305, United States
| | - Jeremy Sokolove
- VA Palo Alto Health Care System, 3801 Miranda Ave, C4-191, Palo Alto, CA 94304, United States; Division of Immunology and Rheumatology, Stanford University, 269 Campus Drive, CCSR 4135, Stanford, CA 94305, United States
| | - Lauren J Lahey
- VA Palo Alto Health Care System, 3801 Miranda Ave, C4-191, Palo Alto, CA 94304, United States; Division of Immunology and Rheumatology, Stanford University, 269 Campus Drive, CCSR 4135, Stanford, CA 94305, United States
| | - Jess D Edison
- Rheumatology Service, Department of Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, United States
| | - William R Gilliland
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States
| | - V Michael Holers
- Division of Rheumatology, University of Colorado Denver School of Medicine, 1775 Aurora Court, Aurora, CO 80045, United States
| | - Kevin D Deane
- Division of Rheumatology, University of Colorado Denver School of Medicine, 1775 Aurora Court, Aurora, CO 80045, United States.
| | - William H Robinson
- VA Palo Alto Health Care System, 3801 Miranda Ave, C4-191, Palo Alto, CA 94304, United States; Division of Immunology and Rheumatology, Stanford University, 269 Campus Drive, CCSR 4135, Stanford, CA 94305, United States.
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35
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Demoruelle MK, Bowers E, Lahey LJ, Sokolove J, Purmalek M, Seto NL, Weisman MH, Norris JM, Kaplan MJ, Holers VM, Robinson WH, Deane KD. Antibody Responses to Citrullinated and Noncitrullinated Antigens in the Sputum of Subjects With Rheumatoid Arthritis and Subjects at Risk for Development of Rheumatoid Arthritis. Arthritis Rheumatol 2018; 70:516-527. [PMID: 29266801 DOI: 10.1002/art.40401] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 12/14/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The location and mechanisms involved in the initial generation of autoantibodies to citrullinated and noncitrullinated proteins/peptides during the natural history of rheumatoid arthritis (RA) development is incompletely understood. This study sought to explore individual antibody responses to citrullinated and noncitrullinated proteins/peptides in the sputum and associations with neutrophil extracellular traps (NETs) in subjects at risk for the future development of RA. METHODS Serum and sputum samples were obtained from 41 RA-free subjects who were considered at risk for the development of RA based on familial or serologic risk factors, from 20 subjects classified as having RA, and from 22 healthy control subjects. Samples were evaluated using a bead-based array for IgG reactivity to 29 citrullinated proteins/peptides and 21 noncitrullinated proteins/peptides. Cutoff levels for antibody positivity were established in a separate control group. NET levels in the sputum were measured using sandwich enzyme-linked immunosorbent assays that quantitate DNA-myeloperoxidase and DNA-neutrophil elastase complexes. RESULTS In at-risk subjects, antibody responses to the citrullinated forms of fibrinogen, apolipoprotein E, and fibronectin were highly prevalent. The most citrulline-specific antibodies in the sputum of at-risk subjects were those to fibrinogen, vimentin, and peptides of fibrinogen A and apolipoprotein A1. Patterns of sputum autoantibody positivity differed between at-risk subjects and subjects with RA. In at-risk subjects, increasing sputum NET levels significantly correlated with several citrullinated and some noncitrullinated antibody reactivities. CONCLUSION These findings suggest that sputum antibody reactivity to particular citrullinated and noncitrullinated proteins/peptides is specific for RA and for subjects at risk of RA, and the association of these proteins/peptides with NETs may be a key feature of early RA-related autoimmunity in the lung. These results further support the hypothesis that the lung plays a role in early RA-related autoimmunity.
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Affiliation(s)
| | | | | | - Jeremy Sokolove
- VA Palo Alto Healthcare System and Stanford University, Stanford, California, and AbbVie Pharmaceuticals, San Francisco, California
| | - Monica Purmalek
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Nickie L Seto
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | - Mariana J Kaplan
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
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Scherer HU, Huizinga TWJ, Krönke G, Schett G, Toes REM. The B cell response to citrullinated antigens in the development of rheumatoid arthritis. Nat Rev Rheumatol 2018; 14:157-169. [DOI: 10.1038/nrrheum.2018.10] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Demoruelle MK, Harrall KK, Ho L, Purmalek MM, Seto NL, Rothfuss HM, Weisman MH, Solomon JJ, Fischer A, Okamoto Y, Kelmenson LB, Parish MC, Feser M, Fleischer C, Anderson C, Mahler M, Norris JM, Kaplan MJ, Cherrington BD, Holers VM, Deane KD. Anti-Citrullinated Protein Antibodies Are Associated With Neutrophil Extracellular Traps in the Sputum in Relatives of Rheumatoid Arthritis Patients. Arthritis Rheumatol 2017; 69:1165-1175. [PMID: 28182854 DOI: 10.1002/art.40066] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/02/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Studies suggest that rheumatoid arthritis (RA)-related autoimmunity is initiated at a mucosal site. However, the factors associated with the mucosal generation of this autoimmunity are unknown, especially in individuals who are at risk of future RA. Therefore, we tested anti-cyclic citrullinated peptide (anti-CCP) antibodies in the sputum of RA-free first-degree relatives (FDRs) of RA patients and patients with classifiable RA. METHODS We evaluated induced sputum and serum samples from 67 FDRs and 20 RA patients for IgA anti-CCP and IgG anti-CCP, with cutoff levels for positivity determined in a control population. Sputum was also evaluated for cell counts, neutrophil extracellular traps (NETs) using sandwich enzyme-linked immunosorbent assays for protein/nucleic acid complexes, and total citrulline. RESULTS Sputum was positive for IgA and/or IgG anti-CCP in 14 of 20 RA patients (70%) and 17 of 67 FDRs (25%), including a portion of FDRs who were serum anti-CCP negative. In the FDRs, elevations of sputum IgA and IgG anti-CCP were associated with elevated sputum cell counts and NET levels. IgA anti-CCP was associated with ever smoking and with elevated sputum citrulline levels. CONCLUSION Anti-CCP is elevated in the sputum of FDRs, including seronegative FDRs, suggesting that the lung may be a site of anti-CCP generation in this population. The association of anti-CCP with elevated cell counts and NET levels in FDRs supports a hypothesis that local airway inflammation and NET formation may drive anti-CCP production in the lung and may promote the early stages of RA development. Longitudinal studies are needed to follow the evolution of these processes relative to the development of systemic autoimmunity and articular RA.
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Affiliation(s)
| | | | - Linh Ho
- University of Colorado Denver at Aurora
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Joshua V, Chatzidionisyou K, Catrina AI. Role of the lung in individuals at risk of rheumatoid arthritis. Best Pract Res Clin Rheumatol 2017; 31:31-41. [DOI: 10.1016/j.berh.2017.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/31/2017] [Accepted: 06/12/2017] [Indexed: 10/18/2022]
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Kelmenson LB, Demoruelle MK, Deane KD. The Complex Role of the Lung in the Pathogenesis and Clinical Outcomes of Rheumatoid Arthritis. Curr Rheumatol Rep 2016; 18:69. [DOI: 10.1007/s11926-016-0618-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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40
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Sparks JA, Chang SC, Deane KD, Gan RW, Demoruelle MK, Feser ML, Moss L, Buckner JH, Keating RM, Costenbader KH, Gregersen PK, Weisman MH, Mikuls TR, O’Dell JR, Holers VM, Norris JM, Karlson EW. Associations of Smoking and Age With Inflammatory Joint Signs Among Unaffected First-Degree Relatives of Rheumatoid Arthritis Patients: Results From Studies of the Etiology of Rheumatoid Arthritis. Arthritis Rheumatol 2016; 68:1828-38. [PMID: 26866831 PMCID: PMC5103164 DOI: 10.1002/art.39630] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 02/04/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine whether genetic, environmental, and serologic rheumatoid arthritis (RA) risk factors are associated with inflammatory joint signs in a cohort of first-degree relatives (FDRs) of RA patients. METHODS We evaluated RA risk factors and inflammatory joint signs in a prospective cohort of FDRs without RA in the Studies of the Etiology of RA. Genetic factors included 5 HLA-DRB1 shared epitope alleles and 45 RA-associated single-nucleotide polymorphisms; loci were combined using genetic risk scores weighted by RA risk. Environmental factors (smoking, body mass index, education, and parity) and RA-related autoantibodies were assessed at baseline. Physical examination was performed at baseline and 2-year follow-up, by observers who were blinded with regard to autoantibody status, to assess inflammatory joint signs as tender or swollen joints at sites typical for RA. Logistic regression was performed to evaluate associations of genetic, environmental, and serologic factors with inflammatory joint signs. RESULTS We analyzed 966 non-Hispanic white FDRs at baseline and 262 at 2-year follow-up after excluding those with inflammatory joint signs at baseline. The mean ± SD age was 47.2 ± 15.5 years, 71% were female, and 55% were shared epitope positive. Smoking >10 pack-years was associated with inflammatory joint signs at baseline (odds ratio [OR] 1.89 [95% confidence interval (95% CI) 1.26-2.82]) and at 2 years (OR 2.66 [95% CI 1.01-7.03]), compared to never smokers. There was a significant interaction between smoking and age with regard to risk of inflammatory joint signs (P = 0.02). FDRs younger than 50 years with >10 pack-years had the highest risk of inflammatory joint signs (OR 4.39 [95% CI 2.22-8.66], compared to never smokers younger than 50 years). CONCLUSION In a high-risk cohort of FDRs, smoking and age were associated with both prevalent and incident inflammatory joint signs at sites typical for RA. Further prospective investigations of the factors affecting the transitions between preclinical RA phases are warranted.
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Affiliation(s)
- Jeffrey A. Sparks
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Shun-Chiao Chang
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kevin D. Deane
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Ryan W. Gan
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - M. Kristen Demoruelle
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Marie L. Feser
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, Colorado
| | - LauraKay Moss
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jane H. Buckner
- Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | | | - Karen H. Costenbader
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Ted R. Mikuls
- Veteran Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | - James R. O’Dell
- Veteran Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | - V. Michael Holers
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jill M. Norris
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Elizabeth W. Karlson
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Terao C, Raychaudhuri S, Gregersen PK. Recent Advances in Defining the Genetic Basis of Rheumatoid Arthritis. Annu Rev Genomics Hum Genet 2016; 17:273-301. [PMID: 27216775 DOI: 10.1146/annurev-genom-090314-045919] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Rheumatoid arthritis (RA) is the most common inflammatory arthritis and exhibits genetic overlap with other autoimmune and inflammatory disorders. Although predominant associations with the HLA-DRB1 locus have been known for decades, recent data have revealed additional insight into the likely causative variants within HLA-DRB1 as well as within other HLA loci that contribute to disease risk. In addition, more than 100 common variants in non-HLA loci have been implicated in disease susceptibility. Genetic factors are involved not only in the development of RA, but also with various disease subphenotypes, including production and circulating levels of autoantibodies and joint destruction. The major current challenge is to integrate these new data into a precise understanding of disease pathogenesis, including the critical cell types and molecular networks involved as well as interactions with environmental factors. We predict that delineating the functional effects of genetic variants is likely to drive new diagnostic and therapeutic approaches to the disease.
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Affiliation(s)
- Chikashi Terao
- Divisions of Genetics and Rheumatology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115.,Partners Center for Personalized Genetic Medicine, Boston, Massachusetts 02115.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142; .,Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto 606-8501, Japan;
| | - Soumya Raychaudhuri
- Divisions of Genetics and Rheumatology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115.,Partners Center for Personalized Genetic Medicine, Boston, Massachusetts 02115.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142; .,Institute of Inflammation and Repair, University of Manchester, M15 6SZ Manchester, United Kingdom.,Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden
| | - Peter K Gregersen
- Robert S. Boas Center for Genomics and Human Genetics, The Feinstein Institute for Medical Research, Manhasset, New York 11030;
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Mikuls TR, Payne JB, Deane KD, Thiele GM. Autoimmunity of the lung and oral mucosa in a multisystem inflammatory disease: The spark that lights the fire in rheumatoid arthritis? J Allergy Clin Immunol 2016; 137:28-34. [PMID: 26768760 DOI: 10.1016/j.jaci.2015.10.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/21/2015] [Accepted: 10/28/2015] [Indexed: 01/23/2023]
Abstract
There is a growing body of evidence to suggest that autoimmunity in patients with rheumatoid arthritis (RA) is initiated outside the joint. This is supported by the observation that circulating autoantibodies, including both rheumatoid factor and anti-citrullinated protein antibody, can be detected in many subjects years before the development of initial joint symptoms leading to an RA diagnosis. Of the potential extra-articular sites implicated in disease initiation, mucosal tissues have garnered increasing attention. Several lines of investigation have separately implicated mucosal tissues from varying anatomic locations as possible initiating sites for RA, including those from the lung and oral cavity. In this review we summarize recent reports incriminating these mucosal tissues as the initial site of autoantibody generation and inflammation in patients with RA.
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Affiliation(s)
- Ted R Mikuls
- Division of Rheumatology, Department of Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Neb; Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Neb.
| | - Jeffrey B Payne
- Division of Rheumatology, Department of Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Neb; Division of Periodontics, Department of Surgical Specialties, College of Dentistry, University of Nebraska Medical Center, Lincoln, Neb
| | - Kevin D Deane
- Division of Rheumatology, Department of Medicine, University of Colorado, Aurora, Colo
| | - Geoffrey M Thiele
- Division of Rheumatology, Department of Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Neb; Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Neb
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Hensvold AH, Frisell T, Magnusson PKE, Holmdahl R, Askling J, Catrina AI. How well do ACPA discriminate and predict RA in the general population: a study based on 12 590 population-representative Swedish twins. Ann Rheum Dis 2016; 76:119-125. [DOI: 10.1136/annrheumdis-2015-208980] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 11/04/2022]
Abstract
ObjectiveAnti-citrullinated protein antibodies (ACPA) are highly specific for rheumatoid arthritis (RA), but the diagnostic accuracy of ACPA in the general population has not been thoroughly assessed. We aimed to assess the diagnostic accuracy of ACPA for RA in the general population and to further characterise the citrullinated peptide recognition pattern.MethodsSerum samples from a large population-representative twin cohort consisting of 12 590 individuals were analysed for the presence of ACPA using anti-CCP2 ELISA. All ACPA-positive samples were further tested on ELISAs for four peptide-specific ACPA. RA cases were identified by linkage to the Swedish National Patient Register at inclusion and after a median follow-up of 37 months (IQR 31–49).Results350 out of 12 590 individuals had a positive anti-CCP2 test, measuring ACPA. Of these, 103 had an RA diagnosis at the time of blood donation and inclusion. During a median follow-up of 3 years, an additional 21 of the remaining 247 ACPA-positive individuals developed RA. Overall, a positive anti-CCP2 test had a positive predictive value of 29% for prevalent RA at inclusion (negative predictive value of 99.6%). High titres (>3× cut-off) of anti-CCP2 increased the positive predictive value to 48% (negative predictive value of 99.5%). ACPA-positive individuals without RA had lower anti-CCP2 titres and fewer peptide-specific ACPA than ACPA-positive patients with RA and higher C reactive protein levels than ACPA-negative individuals without RA.ConclusionPresence of ACPA and especially high titres of anti-CCP2 have a high diagnostic accuracy for an RA diagnosis in a population setting.
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Martínez G, Gómez JA, Bang H, Martínez-Gamboa L, Roggenbuck D, Burmester GR, Torres B, Prada D, Feist E. Carbamylated vimentin represents a relevant autoantigen in Latin American (Cuban) rheumatoid arthritis patients. Rheumatol Int 2016; 36:781-91. [PMID: 27038800 PMCID: PMC4873524 DOI: 10.1007/s00296-016-3472-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 03/22/2016] [Indexed: 11/24/2022]
Abstract
Smoking produces substances that activate proinflammatory, prothrombotic and vasoconstrictive mediators via posttranslational carbamylation of proteins. As a new consequence of carbamylation, induction of anti-carbamylated autoantibodies were observed in rheumatoid arthritis (RA) patients, sometimes prior to onset of the disease. The overall aim of this study was to characterize the reactivity of different isotypes of autoantibodies against carbamylated antigens of vimentin in relation to established rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA) and markers of disease activity in a so far largely uncharacterized population of Latin American (Cuban) patients with RA. Antigenic properties of carbamylated vimentin as well as vimentin peptides were analyzed in 101 patients with RA, 50 disease controls and 51 healthy controls. The diagnostic performance was compared with established commercial ELISA rheumatoid factor, anti-cyclic citrullinated peptide antibodies of second generation (anti-CCP2) and anti-mutated citrullinated vimentin (anti-MCV) antibodies. Prevalence of anti-MCV IgG (86 %), anti-carbamylated vimentin (carbVIM) IgG (77 %) and anti-carbamylated MCV (carbMCV) IgG antibodies (65 %) was higher than the classical RF IgM (60 %) and anti-CCP2 IgG (52 %) in this RA cohort. Of note, smoking status was associated with positive IgG antibody reactivity against CCP2 in 75.0 % and against MCV in 90 % of patients. Furthermore, IgM antibody response against carbMCV and carbVIM was observed in 80 and 90.0 % of smokers, respectively. Due to a high sensitivity of the IgM antibody isotype of anti-carbVIM of 85.2 %, the combination of ACPA with anti-carbVIM IgM provided the best diagnostic performance so far achieved in a RA cohort of this ethnic origin. We demonstrate a high prevalence of anti-carbVIM antibodies and correlation with smoking in Latin American (Cuban) RA patients. Anti-carbVIM IgM represents an useful marker in ACPA-negative patients and, in combination with ACPA IgG assays, optimizes the strategy for autoantibody testing.
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Affiliation(s)
- Goitybell Martínez
- Department for Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany. .,Immunology Laboratory, National Center of Medical Genetic, Havana, Cuba.
| | | | | | - Lorena Martínez-Gamboa
- Department for Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Dirk Roggenbuck
- Faculty of Science, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany.,Medipan GmbH, Dahlewitz/Berlin, Germany
| | - Gerd-Rüdiger Burmester
- Department for Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Barbara Torres
- Immunology Laboratory, National Center of Medical Genetic, Havana, Cuba
| | | | - Eugen Feist
- Department for Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
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Nam JL, Hunt L, Hensor EMA, Emery P. Enriching case selection for imminent RA: the use of anti-CCP antibodies in individuals with new non-specific musculoskeletal symptoms – a cohort study. Ann Rheum Dis 2015; 75:1452-6. [DOI: 10.1136/annrheumdis-2015-207871] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/11/2015] [Indexed: 11/03/2022]
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Merashli M, Jawad AS. Rheumatoid arthritis in the Kingdom of Saudi Arabia. Saudi Med J 2015; 36:638. [PMID: 25935189 PMCID: PMC4436765 DOI: 10.15537/smj.2015.5.11639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mira Merashli
- Department of Rheumatology, The Royal London Hospital, London, United Kingdom. E-mail.
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Valesini G, Gerardi MC, Iannuccelli C, Pacucci VA, Pendolino M, Shoenfeld Y. Citrullination and autoimmunity. Autoimmun Rev 2015; 14:490-7. [PMID: 25636595 DOI: 10.1016/j.autrev.2015.01.013] [Citation(s) in RCA: 171] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 01/19/2015] [Indexed: 01/27/2023]
Abstract
Autoimmune diseases are characterized by the body's own immune system attack to the self-tissues, a condition enabled, in predisposed subjects, by the reduction of self-tolerance. A central role has been recently recognized to post-translational modifications, since they can promote generation of neo-(auto)antigens and in turn an autoimmune response. During the last years great attention has been paid to citrullination, because of its role in inducing anti-citrullinated proteins/peptide antibodies (ACPA), a class of autoantibodies with diagnostic, predictive and prognostic value for Rheumatoid Arthritis (RA). Nonetheless, citrullination has been reported to be a process present in a wide range of inflammatory tissues. Indeed, citrullinated proteins have been detected also in other inflammatory arthritides and in inflammatory conditions other than arthritides (polymyositis, inflammatory bowel disease and chronic tonsillitis). Moreover, environmental exposure to cigarette smoke and nanomaterials of air pollution may be able to induce citrullination in lung cells prior to any detectable onset of inflammatory responses, suggesting that protein citrullination could be considered as a sign of early cellular damage. Accordingly, citrullination seems to be implicated in all those para-physiological processes, such as cells death pathways, in which intracellular calcium concentration raises to higher levels than in physiologic conditions: hence, peptidylarginine deiminases enzymes are activated during apoptosis, autophagy and NETosis, processes which are well-known to be implicated in autoimmunity. Taken together, these data support the hypothesis that rather than being a disease-dependent process, citrullination is an inflammatory-dependent condition that plays a central role in autoimmune diseases.
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Affiliation(s)
- Guido Valesini
- Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia - Sapienza Università di Roma, Rome, Italy.
| | - Maria C Gerardi
- Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia - Sapienza Università di Roma, Rome, Italy
| | - Cristina Iannuccelli
- Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia - Sapienza Università di Roma, Rome, Italy
| | - Viviana A Pacucci
- Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia - Sapienza Università di Roma, Rome, Italy
| | - Monica Pendolino
- Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia - Sapienza Università di Roma, Rome, Italy
| | - Yehuda Shoenfeld
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel-Aviv University, Israel
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Abstract
Multiple studies demonstrate that there is a period of development of rheumatoid arthritis (RA) during which there are elevations of disease-related biomarkers, including autoantibodies, in the absence of and prior to the development of RA; this period can be termed 'preclinical RA'. These 'preclinical' autoantibodies including rheumatoid factor and antibodies to citrullinated protein antigens, and more recent studies have also identified additional autoantibodies and a wide range of inflammatory biomarkers. These findings in conjunction with established and emerging data about genetic and environmental risk factors for RA support a model of disease development where certain factors lead to an initial triggering of RA-related autoimmunity that expands over time to the point where symptomatic arthritis classifiable as RA develops. Herein will be reviewed updates in the field, as well as a discussion of current limitations of our understanding of preclinical RA, and potential future directions for study.
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Holers VM. Insights from populations at risk for the future development of classified rheumatoid arthritis. Rheum Dis Clin North Am 2014; 40:605-20. [PMID: 25437280 PMCID: PMC4250577 DOI: 10.1016/j.rdc.2014.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Rheumatoid arthritis (RA) develops through a series of stages. In the seropositive subset of classified RA patients, a preclinical stage is present for years before the onset of clinically apparent disease. Relevant preclinical biomarkers include autoantibodies, alterations of lymphoid populations, elevated cytokines/chemokines, genetic/genomic factors, imaging studies, clinical findings, dietary and environmental biomarkers, cardiovascular disease risk assessment, microbiome analyses, and metabolomic changes. Identifying the population of asymptomatic subjects at sufficiently high risk for disease to be informative and representative of "preclinical patients" is a challenge. This article reviews the results of analyses that have been undertaken in these "at-risk" subjects.
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Affiliation(s)
- V Michael Holers
- Division of Rheumatology, University of Colorado School of Medicine, Room 3102E, 1775 Aurora Court, Aurora, CO 80045, USA.
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50
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Kung TN, Bykerk VP. Detecting the earliest signs of rheumatoid arthritis: symptoms and examination. Rheum Dis Clin North Am 2014; 40:669-83. [PMID: 25437284 DOI: 10.1016/j.rdc.2014.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Signs and symptoms often occur well in advance of a formal diagnosis of rheumatoid arthritis (RA). However, these do not necessarily represent symptoms that are included in classification criteria. Their intensity, frequency, and persistence over time seem to be important in the spectrum from preclinical autoimmunity to classifiable RA. Prospective study of signs and symptoms in individuals at risk for RA will help to determine their onset and relationship with epitope spreading, cytokine evolution, sensitive imaging, and their usefulness in discriminating between individuals patients who will develop incident inflammatory arthritis versus normal controls.
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Affiliation(s)
- Tabitha N Kung
- Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario M5T3L9, Canada
| | - Vivian P Bykerk
- Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY 10021, USA.
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