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Absence of cyclic citrullinated peptide antibody in nonarthritic patients with chronic hepatitis C infection
Douglas Lienesch1, Robert Morris, Allan Metzger
1Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. lienesd@ucmail.uc.edu
Insights
Rheumatoid factor (RF) is common in hepatitis C virus (HCV) infection, reducing its accuracy for diagnosing rheumatoid arthritis (RA). Cyclic citrullinated peptide (CCP) antibodies are not elevated in HCV, suggesting improved diagnostic utility for RA in this population.
Area of Science:
- Immunology
- Hepatology
- Rheumatology
Background:
- Rheumatoid factor (RF) is frequently detected in patients with chronic hepatitis C virus (HCV) infection.
- The high prevalence of RF in HCV patients reduces its diagnostic specificity for rheumatoid arthritis (RA).
- Cyclic citrullinated peptide (CCP) antibodies are highly specific biomarkers for RA in the general population.
Purpose of the Study:
- To evaluate the diagnostic utility of CCP antibodies for RA in HCV-infected patients.
- To determine the prevalence of CCP antibodies in nonarthritic HCV patients.
- To examine the relationship between RF production and CCP antibody levels in HCV infection.
Main Methods:
- Serum samples from nonarthritic patients with chronic HCV infection were analyzed.
- CCP antibodies and RF isotypes (IgM, IgG, IgA) were quantified using ELISA.
- Regression analysis was employed to assess correlations between CCP antibodies and RF levels.
Main Results:
- RF (IgG, IgM, IgA) was detected in 54% of the 50 HCV patients studied.
- CCP antibodies were detected at marginally elevated levels in only one patient (2%).
- Serum CCP antibody levels did not correlate with RF levels.
Conclusions:
- CCP antibody is not increased in patients with HCV infection.
- Unlike RF, CCP antibody retains its specificity in the context of HCV infection.
- CCP antibody shows potential for improved diagnostic utility in identifying RA among HCV patients.
Objective:
The increased prevalence of rheumatoid factor (RF) in patients with chronic hepatitis C virus (HCV) infection markedly diminishes the diagnostic specificity of serum rheumatoid factor (RF) for rheumatoid arthritis (RA) in patients with HCV. Cyclic citrullinated peptide (CCP) antibody, a highly specific biomarker for RA in the general population, may have better diagnostic utility for RA in the HCV population. To investigate if CCP antibody retains its specificity for RA in HCV infection, we determined the prevalence of CCP antibodies and examined the relationship between RF production and CCP antibody levels in a population of nonarthritic patients with chronic HCV infection.
Methods:
CCP antibody and IgM, IgG, and IgA RF isotypes were determined by ELISA in serum from nonarthritic patients with chronic HCV infection.
Results:
In a series of 50 HCV patients, IgG-RF, IgM-RF, and IgA-RF were detectable in 52%, 26%, and 14%, respectively, with a total seropositivity rate of 54%. Marginally elevated CCP antibody was detected in a single patient (2%). By regression analysis, serum levels of CCP antibodies did not correlate with RF levels.
Conclusion:
In contrast to RF, CCP antibody is not increased in HCV infection. CCP antibody may have improved utility for the diagnosis of RA in this patient population.
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