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Anti-CCP antibody in patients with established rheumatoid arthritis: Does it predict adverse cardiovascular profile?
Banerjee Arnab1, Ghosh Biswadip, Pande Arindam
1Department of Medicine, Medical College and Hospital, Kolkata 700 073, West Bengal, India.
Insights
Anti-cyclic citrullinated peptide (CCP) antibodies in rheumatoid arthritis (RA) patients are linked to increased cardiovascular risks, including arterial thickening and heart dysfunction. Early evaluation for cardiac complications is crucial for anti-CCP positive RA individuals.
Area of Science:
- Rheumatology
- Cardiology
- Immunology
Background:
- Rheumatoid arthritis (RA) is a significant risk factor for cardiovascular (CV) events and mortality.
- Anti-cyclic citrullinated peptide (CCP) antibodies are associated with more severe RA, including extra-articular manifestations and poorer outcomes.
Purpose of the Study:
- To investigate anti-CCP antibody as an independent risk factor for CV complications in RA patients.
- To assess CV complications using carotid intima-medial thickness and echocardiography.
Main Methods:
- An observational, cross-sectional study included 80 RA patients with disease duration of at least 3 years.
- Exclusion criteria: known CV risk factors, heart disease, or family history of premature ischemic heart disease.
- Patients were categorized into anti-CCP antibody positive (n=40) and negative groups.
Main Results:
- Anti-CCP positive RA patients exhibited higher inflammatory markers (CRP) and joint symptoms.
- Significantly increased carotid intima-medial thickness was observed in the anti-CCP positive group (P=0.029).
- Lower left ventricular ejection fraction (P=0.01), diastolic dysfunction (P=0.034), and mild pericardial thickening (12.5%) were more prevalent in anti-CCP positive patients.
Conclusions:
- Anti-CCP antibodies play a crucial role in RA-associated myocardial dysfunction, driven by inflammation.
- Anti-CCP positive RA patients show higher rates of atherosclerotic vascular and cardiac abnormalities.
- Meticulous CV morbidity evaluation is recommended for anti-CCP positive RA patients with prolonged disease duration and high activity.
Background:
Rheumatoid arthritis (RA) is an independent risk factor for adverse cardiovascular (CV) events that accounts for a significant proportion of mortality among these patients. Anti-CCP antibodies are associated with higher frequency of extra-articular manifestations and poorer outcomes in RA.
Aims:
To determine the role of anti-cyclic citrullinated peptide (CCP) antibody as an independent risk factor for developing CV complications as documented by carotid intima medial thickness and abnormal echocardiography in established RA patients.
Materials And Methods:
Eighty patients of RA having disease duration of at least 3 years participated in this hospital-based, cross-sectional, and observational study. Forty patients were anti-CCP antibody positive. Patients of established RA having known CV risk factors, known heart disease, or family history of premature ischemic heart disease were excluded.
Results:
Anti-CCP positive group had early morning stiffness, tender and swollen joint count, and c-reactive protein (CRP) level significantly higher than those in anti-CCP negative group. Average intima-medial thicknesses of common carotid arteries were also significantly higher among anti-CCP positive group (P = 0.029) and were positively correlated with patients' age and disease duration. Lower left ventricular ejection fraction and left ventricular diastolic dysfunction were more commonly dispersed among the anti-CCP positive patients with P values of 0.01 and 0.034, respectively. Mild pericardial thickening was documented among 12.5% patients of anti-CCP positive group, while none of the anti-CCP negative patients had similar findings in echocardiography.
Conclusion:
This study stressed on the important role of anti-CCP antibody in myocardial dysfunction due to inflammation in RA patients. Both atherosclerotic vascular involvement and cardiac abnormalities including pericardial, myocardial, and endocardial involvements were higher among anti-CCP positive RA patients. Hence, patients with high titer of anti-CCP antibody associated with prolonged disease duration and increased disease activity should be evaluated for CV morbidity more meticulously.
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