title: Anti-CCP antibody in patients with established rheumatoid arthritis: Does it predict adverse cardiovascular profile?
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Medical College and Hospital, Kolkata 700 073, West Bengal, India.
authors.forename: Banerjee
authors.initials: B
authors.lastname: Arnab
authors.forename: Ghosh
authors.initials: G
authors.lastname: Biswadip
authors.forename: Pande
authors.initials: P
authors.lastname: Arindam
authors.forename: Mandal
authors.initials: M
authors.lastname: Shyamash
authors.forename: Ghosh
authors.initials: G
authors.lastname: Anirban
authors.forename: Palui
authors.initials: P
authors.lastname: Rajan
keywords: Anti-CCP antibody; Cardiovascular complications; Carotid intima-medial thickness; Rheumatoid arthritis
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