title: Remittent non-destructive polysynovitis in P-ANCA-positive vasculitis patients with anti-CCP antibodies.
abstract: Patients with antineutrophil cytoplasm antibodies (ANCA)-associated vasculitis (AASV) commonly suffer from arthralgias and, sometimes, polyarthritis during disease flares. Although rheumatoid factor (RF) can be detected in up to 37-50% of AASV patients, anti-cyclic citrullinated peptide (anti-CCP) antibodies are rare. Herein, we describe the clinical features of five P-ANCA-positive vasculitis patients, who had persistent and/or high anti-CCP levels and, more importantly, suffered from remittent non-destructive arthralgias and polysynovitis, independently of the vasculitis course and without evidence of RA. Two were initially thought to have RA rather than microscopic polyangiitis and, at AASV diagnosis, all had kidney involvement and three had alveolar hemorrhages. With a median follow-up of 30 months, one suffered vasculitis relapses, preceded by polysynovitis, and others had remittent arthralgias and polysynovitis, while their vasculitides remained in remission. None of these patients had radiological destructive arthritis. We discuss the challenge of diagnosing these patients positive for anti-CCP and ANCA, and with dominant articular manifestations. AASV patients with anti-CCP antibodies may experience relapsing polysynovitis and non-erosive polyarthritis prior to vasculitis flares, but also independently of the vasculitis course, which is uncommon in AASV, and might represent a small subgroup of AASV patients.
authors.affiliation: Department of Internal Medicine, National Referral Center for Necrotizing Vasculitides and Systemic Sclerosis, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris Descartes, 27, rue du Faubourg-Saint-Jacques, 75879 Paris cedex 14, France. christian.pagnoux@cch.aphp.fr
authors.forename: Christian
authors.initials: C
authors.lastname: Pagnoux
authors.forename: Raphaèle
authors.initials: R
authors.lastname: Seror
authors.forename: Alice
authors.initials: A
authors.lastname: Bérezné
authors.forename: Samir
authors.initials: S
authors.lastname: Rouabhia
authors.forename: Claire
authors.initials: C
authors.lastname: Goulvestre
authors.forename: Loïc
authors.initials: L
authors.lastname: Guillevin
mesh_terms: D000328:Adult; D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology*; D009195:Peroxidase / Q000276:immunology; D012008:Recurrence; D013585:Synovitis / Q000097:blood* / Q000150:complications; D014657:Vasculitis / Q000097:blood* / Q000150:complications
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D015415:Biomarkers; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D009195:Peroxidase