Frequency and significance of antibodies to cyclic citrullinated peptide in type 1 autoimmune hepatitis.
OBJECTIVE
Determine the frequency, clinical phenotype, and prognostic implications of antibodies against cyclic citrullinated peptides in patients with type 1 autoimmune hepatitis.


METHODS
Three hundred and ninety-five serum samples from 179 patients were tested by enzyme-linked immunosorbent assay, and findings correlated with clinical and histological features, frequency of HLA DR3 and DR4, and treatment outcome.


RESULTS
Twenty patients (11%) had antibodies against cyclic citrullinated peptides. Seropositivity was associated with a higher frequency of rheumatoid arthritis (RA) (25 vs. 0%, P < 0.001). Patients with antibodies against cyclic citrullinated peptides also had a significantly greater occurrence of histological cirrhosis at presentation (47 vs. 20%, P = 0.01) and death from hepatic failure than seronegative patients (25 vs. 9%, P = 0.04). Cirrhosis at presentation occurred more commonly in the patients with antibodies against cyclic citrullinated peptides and RA than in the other patients (100 vs. 21%, P = 0.005).


CONCLUSIONS
Antibodies against cyclic citrullinated peptides occur in a subgroup of patients with type 1 autoimmune hepatitis who have a greater occurrence of cirrhosis at presentation and death from hepatic failure. Their presence with RA at accession characterizes a subgroup with cirrhosis.
Montano-Loza
Aldo
A
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Czaja
Albert J
AJ
Carpenter
Herschel A
HA
Piette
Andrea
A
Murphy
Daniel
D
Shums
Zakera
Z
Burlingame
Rufus
R
Norman
Gary L
GL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology; D001219:Aspartate Aminotransferases / Q000097:blood; D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D001379:Azathioprine / Q000627:therapeutic use; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015803:HLA-DR3 Antigen / Q000097:blood; D015804:HLA-DR4 Antigen / Q000097:blood; D019693:Hepatitis, Autoimmune / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology*; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies
D001323:Autoantibodies; D015803:HLA-DR3 Antigen; D015804:HLA-DR4 Antigen; D007166:Immunosuppressive Agents; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D001219:Aspartate Aminotransferases; D001379:Azathioprine; D011241:Prednisone