ANTIBODIES AGAINST CYCLIC CITRULLINATED PEPTIDE AND AGAINST MODIFIED CITRULLINATED VIMENTIN IN PATIENTS WITH PSORIATIC ARTHRITIS- IS THERE A RELATIONSHIP TO JOINT EROSIONS?

Background: In connection with the development of new, aggressive treatment strategies in arthritic diseases, there evolves need for correct diagnosis as well as prediction of further development, as far as possible in early stages of the disease. In our previous study (1) we found the presence of at least one of the antibodies against citrullinated peptides (anti-CCP2 and antibodies against a modified citrullinated vimentin - anti-MCV respectively) in 11, 3% patients.The most striking was the six time higher prevalence of anti-MCV antibodies in the absence of anti-CCP2 antibodies as vice-versa.Objectives: In this study we tried to find out the relationship between the presence of these autoantibodies and the occurrence of peripheral joint erosions in patients with psoriatic arthritis followed on a long-term basis in the Institute of Rheumatology Prague.Methods: Serum levels of anti-CCP and anti-MCV antibodies were examined in 110 patients with psoriatic arthritis. The diagnosis of psoriatic arthritis was determined using Moll and Wright criteria. Serum levels of anti-CCP2 were tested using ELISA method (Eurodiagnostika, Germany), anti-MCV using ELISA method (Orgentec, Germany). X-rays of hands and feet were assessed according to modified Steinbrocker method (2).Results: Titres of both autoantibodies were examined in 110 patients. The presence of anti-CCP was disclosed in 4.5% and anti-MCV in 18% of patients. Contemporary presence of both antibodies was found in only 4, 5%. Isolated positivity of anti-CCP antibodies was not found. On the other hand, isolated positivity of anti-MCV antibodies was present in 12% of the patients. Rheumatoid factors were positive only in 2 cases (1, 8%) and in both cases were associated whit the positivity of anti-CCP as well as anti-MCV antibodies. One of them has a typical x-ray and clinical picture of psoriatic arthritis including spondylitis, the diagnosis of the second one is not unequivocal and allows the possibility of rheumatoid arthritis with psoriasis.X-rays of the hands and feet of 57 patients were available for assessment. Erosions were present in 75% of these patients (Steinbrocker average score 27, 1; range 1–78). In the erosive group 19% of patients were anti-MCV positive as compared with only 2% of patients with anti-CCP positivity.Conclusion: The presence of antibodies against citrullinated peptides is less prevalent in patients with psoriatic arthritis as compared with patients with rheumatoid arthritis. Nevertheless their presence is repeatedly found in considerable amount of patients with psoriatic arthritis. As opposed to rheumatoid arthritis the presence of anti-MCV is more prevalent then that of anti-CCP. At the same time the presence of anti-MCV is significantly more often associated with joint erosions then with anti-CCP.So the presence of the autoantibodies against citrullinated peptides not only not excludes the diagnosis of psoriatic arthritis, but as in the case of anti-MCV may be associated with evolution of joint erosions.References: 1. J. Stolfa, L. Sedova, I. Putova, J. Vencovsky Antibodies against cyclic citrullinated peptide and against modified citrullinated with psoriatic arthritis, Ann Rheum Dis 2007;66(Suppl II):4202. Rahman P, Gladman DD, Cook RJ, Zhou Y, Young G, Salonen D. Radiological assessment in psoriatic arthritis. Br J Rheumatol 1998; 37:760-5.Citation: Ann Rheum Dis, volume 67, supplement II, year 2008, page 532Session: Psoriatic arthritis