Anti-citrullinated peptide antibodies may occur in patients with psoriatic arthritis.
BACKGROUND
Anti-cyclic citrullinated peptide (anti-CCP) antibodies are considered highly specific markers of rheumatoid arthritis. Despite the high specificity of the test, anti-CCP antibodies have also been observed in psoriatic arthritis.


OBJECTIVE
To determine the frequency of anti-CCP antibodies in psoriatic arthritis and to describe the clinical characteristics of such patients.


METHODS
Serum samples from 192 patients with psoriatic arthritis were analysed for anti-CCP antibodies. A previously defined cut off point was applied at a specificity level of > or =98.5% (42 U/ml). Antibodies against pepA and pepB (two synthetic citrullinated peptides) were determined on samples containing anti-CCP antibodies by line immune assay. The swollen joint count and the numbers of affected joints (present or past) were recorded. Clinical features were noted and if available radiographs of hands and feet were scored for erosions. Rheumatoid factor was determined in all samples.


RESULTS
Anti-CCP antibodies were found in 15 patients (7.8%); 13 of 15 anti-CCP2 positive samples were also positive for anti-pepA or pepB antibodies. The prevalence of anti-CCP antibodies was higher than expected in view of the highly specific cut off applied in the test. Detailed analysis of the clinical and radiological features makes it improbable that the high prevalence of anti-CCP antibodies resulted solely from concomitant psoriasis and rheumatoid arthritis or from misclassification.


CONCLUSIONS
Anti-CCP antibodies may be present in patients with psoriatic arthritis. Although some of the present cohort could have had psoriasis with concomitant rheumatoid arthritis, a proportion at least had the typical characteristics of psoriatic arthritis as the primary diagnosis.
Vander Cruyssen
B
B
Department of Rheumatology, De Pintelaan 185, Ghent University Hospital, B-9000 Gent, Belgium. bert.vandercruyssen@ugent.be
Hoffman
I E A
IE
Zmierczak
H
H
Van den Berghe
M
M
Kruithof
E
E
De Rycke
L
L
Mielants
H
H
Veys
E M
EM
Baeten
D
D
De Keyser
F
F
D000293:Adolescent; D000328:Adult; D015535:Arthritis, Psoriatic / Q000000981:diagnostic imaging / Q000276:immunology* / Q000473:pathology; D001323:Autoantibodies / Q000097:blood*; D001324:Autoantigens / Q000276:immunology; D005260:Female; D005528:Foot / Q000000981:diagnostic imaging; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology*; D011859:Radiography; D012217:Rheumatoid Factor / Q000097:blood; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D001323:Autoantibodies; D001324:Autoantigens; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor