AB1235 Clinical relevance of anti-citrullinated protein antibody for the detection of rheumatoid arthritis in hemodialysis patients. (23rd January 2014)

• Record Type: Journal Article
• Authors: Nakashima, A.; Yamada, K.; Kawano, M.
• Is Part Of: Annals of the rheumatic diseases. Volume 71(2012)Supplement 3
• Page Start: 708
• Page End: 708
• Publication Date: 2014-01-23
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2012-eular.1233
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Hemodialysis (HD) patients are considered to be at increased risk for developing rheumatoid arthritis (RA), as a result of immunologic abnormalities caused by this treatment 1) . Anti-cyclic citrullinated peptide (anti-CCP) antibody testing is particularly useful in the diagnosis of rheumatoid arthritis, with high specificity, especially early in the disease process 2) . Objectives: To determine this possibility, anti-CCP and other autoantibodies, such as rheumatoid factor (RF) and anti-nuclear antibody (ANA) were evaluated. Methods: We examined 113 hemodialysis patients (64 males and 49 females; mean age 65.2±10.6 years). The duration of hemodialysis was 7.9±7.5 years. The etiologies of ESRD were: aortitis syndrome (n=1), glomerulonephritis (n=36), diabetes mellitus (n=36), benign glomerulosclerosis (n=14), polycystic kidney disease (n=6), drug induced renal failure (n=2), hyperparathyroidism (n=2), hypoplastic kidney (n=1), interstitial nephritis (n=1), pregnancy kidney (n=2), purpura nephritis (n=1), RA (n=1), rapidly progressive glomerulonephritis (n=1), and unknown (n=8). Anti-CCP was measured using enzyme-linked immunosorbent assay (ELISA) with the CCP Ab. ELISA "Cosmic" (Cosmic Corporation, Tokyo, Japan). The normal value for anti-CCP reported by the manufacturer is less than 4.5 U/mL. Results: Mean serum value of Anti-CCP of HD patients was 4.8±24.3 U/ml, and five patients (4.4%) were positive for serum anti-CCP, three of whom showed high titers (64.3, 165.6, and 192.2 U/mL). Two of these patients developed RA after starting HD. Six patients (5.3%) were positive for ANA, and ten patients (8.8%) for RF. Conclusions: Our results indicated that HD patients had increased values of anti-CCP more frequently than the normal population and some of them developed RA. Romic et al 3) reported that anti-CCP and RF concentrations were not changed in HD patients, but increased values of anti-CCP were detected in four of fifty-seven HD patients. They did not describe any signs or symptoms in HD patients who showed increased values of anti-CCP and suggested that HD is not likely to be a trigger for development of RA. Contrary to these findings, our results suggested that HD might indeed trigger RA. Future prospective studies are needed to determine if anti-CCP is an early predictor of RA in HD patients who might be at greater risk of developing this condition. References: Gagnon RF, Shuster J, Kaye M. Auto-immunity in patients with end-stage renal disease maintained on hemodialysis and continuous ambulatory peritoneal dialysis. J Clin Lab Immunol 1983; 11, 155-158. Niewold TB, Harrison MJ, Paget SA. Anti-CCP testing as a diagnostic and prognostic tool in rheumatoid arthritis. QJM 2007; 100, 193-201. Romic Z, Unic A, Derek L et al. Anti-citrullinated protein antibody and rheumatoid factor in patients with end-stage renal disease. Clin Chem Lab Med 2009; 47, 959-962. Disclosure of Interest: None Declared