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Profiling anti-cyclic citrullinated peptide antibodies in patients with juvenile idiopathic arthritis

Anne E Tebo1, Troy Jaskowski, K Wayne Davis

  • 1Department of Pediatrics and Human Genetics, Emory University School of Medicine, 2015 Uppergate Drive NE, Atlanta, GA, 30322, USA. sprahal@emory.edu.

Pediatric Rheumatology Online Journal
|August 31, 2012
PubMed

Insights

Anti-citrullinated protein/peptide antibodies (ACPA) are found in 14% of children with juvenile idiopathic arthritis (JIA). ACPA-positive, rheumatoid factor-negative JIA may represent a distinct subgroup requiring specific classification.

Area of Science:

  • Pediatric Rheumatology
  • Immunology
  • Autoimmunity

Background:

  • Anti-citrullinated protein/peptide antibodies (ACPA) are highly specific for rheumatoid arthritis (RA).
  • Juvenile idiopathic arthritis (JIA) can phenotypically mimic RA, with some patients testing positive for rheumatoid factor (RF).
  • The prevalence and significance of ACPA in JIA remain under investigation.

Purpose of the Study:

  • To determine the prevalence of ACPA in a JIA cohort.
  • To examine the relationship between ACPA, RF, and other serologic markers in JIA.
  • To explore potential distinct JIA subsets based on ACPA and RF status.

Main Methods:

  • Sera from 334 children with JIA and 50 healthy controls were analyzed using ELISA.
  • Tests included anti-cyclic citrullinated peptide (anti-CCP) IgG, RF (IgM, IgA, IgG), anti-RA33 IgG, and antinuclear antibodies (ANA).
  • Statistical comparisons utilized Chi-square, Fisher exact tests, and T-tests.

Main Results:

  • ACPA prevalence was 14.3% in JIA cases versus 2% in controls (OR 8.2, p <0.01).
  • RF prevalence was 12% in JIA cases and 8% in controls.
  • ACPA-positive, RF-negative JIA patients (n=23) had earlier onset (4.6 years) and fewer HLA-DRB1 alleles than RF/ACPA-positive patients (n=25).

Conclusions:

  • ACPA are detectable in a significant subset (14%) of children with JIA.
  • A frequent subgroup of JIA patients presents with ACPA but without RF, suggesting a distinct clinical entity.
  • ACPA testing may be valuable for JIA classification and understanding disease subsets.
Abstract

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