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Anti-type II collagen antibodies, anti-CCP, IgA RF and IgM RF are associated with joint damage, assessed eight years after onset of juvenile idiopathic arthritis (JIA).

Berntson L, Nordal E, Fasth A, Aalto K, Herlin T, Nielsen S, Rygg M, Zak M, Rönnelid J, Nordic Study Group of Pediatric Rheumatology (NoSPe - Pediatr Rheumatol Online J (2014)

Bottom Line: Elevated serum levels of anti-CII occurred in 3.1%, IgM RF in 3.6%, IgA RF in 3.1% and anti-CCP in 2.6% of the patients.Occurrence of RF and anti-CCP did to some extent overlap, but rarely with anti-CII.The role of anti-CII in JIA should be further studied.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.

ABSTRACT

Background: Early appearance of antibodies specific for native human type II collagen (anti-CII) characterizes an early inflammatory and destructive phenotype in adults with rheumatoid arthritis (RA). The objective of this study was to investigate the occurrence of anti-CII, IgM RF, IgA RF and anti-CCP in serum samples obtained early after diagnosis, and to relate the occurrence of autoantibodies to outcome after eight years of disease in children with juvenile idiopathic arthritis (JIA).

Methods: The Nordic JIA database prospectively included JIA patients followed for eight years with data on remission and joint damage. From this database, serum samples collected from 192 patients, at a median of four months after disease onset, were analysed for IgG anti-CII, IgM RF, IgA RF and IgG anti-CCP. Joint damage was assessed based on Juvenile Arthritis Damage Index for Articular damage (JADI-A), a validated clinical instrument for joint damage.

Results: Elevated serum levels of anti-CII occurred in 3.1%, IgM RF in 3.6%, IgA RF in 3.1% and anti-CCP in 2.6% of the patients. Occurrence of RF and anti-CCP did to some extent overlap, but rarely with anti-CII. The polyarticular and oligoarticular extended categories were overrepresented in patients with two or more autoantibodies. Anti-CII occurred in younger children, usually without overlap with the other autoantibodies and was associated with high levels of C-reactive protein (CRP) early in the disease course. All four autoantibodies were significantly associated with joint damage, but not with active disease at the eight-year follow up.

Conclusions: Anti-CII, anti-CCP, IgA RF and IgM RF detected early in the disease course predicted joint damage when assessed after eight years of disease. The role of anti-CII in JIA should be further studied.

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Association between the occurrence of four autoantibodies and early CRP levels in 134 (of 192) patients with JIA where blood samples were obtained ≤ 10 months after onset of disease. P-values denote differences in median CRP levels between patients with and without the corresponding autoantibodies investigated with the Mann-Whitney’s U test. Horizontal lines indicate median levels. All CRP levels ≤ 10 mg/L were set to 3 g/L.
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Figure 1: Association between the occurrence of four autoantibodies and early CRP levels in 134 (of 192) patients with JIA where blood samples were obtained ≤ 10 months after onset of disease. P-values denote differences in median CRP levels between patients with and without the corresponding autoantibodies investigated with the Mann-Whitney’s U test. Horizontal lines indicate median levels. All CRP levels ≤ 10 mg/L were set to 3 g/L.

Mentions: When patient antibodies were correlated to the JADI-A scores, we found a highly significant association to the number of antibodies detected (p = 0.0001). The correlation coefficients were, however, low for the commonly tested antibodies (anti-CCP, IgM RF and IgA RF) (Spearman’s ρ = 0.30) and did not increase when anti-CII were included (Spearman’s ρ = 0.31).Information on CRP levels taken ≤ 10 months after disease onset were available for 134/192 patients. CRP taken early in the disease course were significantly higher (more than four times higher) in anti-CII positive patients than in anti-CII negative patients (median 30.0 vs. 8.7 mg/l; p = 0.0001). No such association was found for any of the other antibodies studied (Figure 1).


Anti-type II collagen antibodies, anti-CCP, IgA RF and IgM RF are associated with joint damage, assessed eight years after onset of juvenile idiopathic arthritis (JIA).

Berntson L, Nordal E, Fasth A, Aalto K, Herlin T, Nielsen S, Rygg M, Zak M, Rönnelid J, Nordic Study Group of Pediatric Rheumatology (NoSPe - Pediatr Rheumatol Online J (2014)

Association between the occurrence of four autoantibodies and early CRP levels in 134 (of 192) patients with JIA where blood samples were obtained ≤ 10 months after onset of disease. P-values denote differences in median CRP levels between patients with and without the corresponding autoantibodies investigated with the Mann-Whitney’s U test. Horizontal lines indicate median levels. All CRP levels ≤ 10 mg/L were set to 3 g/L.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4061516&req=5

Figure 1: Association between the occurrence of four autoantibodies and early CRP levels in 134 (of 192) patients with JIA where blood samples were obtained ≤ 10 months after onset of disease. P-values denote differences in median CRP levels between patients with and without the corresponding autoantibodies investigated with the Mann-Whitney’s U test. Horizontal lines indicate median levels. All CRP levels ≤ 10 mg/L were set to 3 g/L.
Mentions: When patient antibodies were correlated to the JADI-A scores, we found a highly significant association to the number of antibodies detected (p = 0.0001). The correlation coefficients were, however, low for the commonly tested antibodies (anti-CCP, IgM RF and IgA RF) (Spearman’s ρ = 0.30) and did not increase when anti-CII were included (Spearman’s ρ = 0.31).Information on CRP levels taken ≤ 10 months after disease onset were available for 134/192 patients. CRP taken early in the disease course were significantly higher (more than four times higher) in anti-CII positive patients than in anti-CII negative patients (median 30.0 vs. 8.7 mg/l; p = 0.0001). No such association was found for any of the other antibodies studied (Figure 1).

Bottom Line: Elevated serum levels of anti-CII occurred in 3.1%, IgM RF in 3.6%, IgA RF in 3.1% and anti-CCP in 2.6% of the patients.Occurrence of RF and anti-CCP did to some extent overlap, but rarely with anti-CII.The role of anti-CII in JIA should be further studied.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.

ABSTRACT

Background: Early appearance of antibodies specific for native human type II collagen (anti-CII) characterizes an early inflammatory and destructive phenotype in adults with rheumatoid arthritis (RA). The objective of this study was to investigate the occurrence of anti-CII, IgM RF, IgA RF and anti-CCP in serum samples obtained early after diagnosis, and to relate the occurrence of autoantibodies to outcome after eight years of disease in children with juvenile idiopathic arthritis (JIA).

Methods: The Nordic JIA database prospectively included JIA patients followed for eight years with data on remission and joint damage. From this database, serum samples collected from 192 patients, at a median of four months after disease onset, were analysed for IgG anti-CII, IgM RF, IgA RF and IgG anti-CCP. Joint damage was assessed based on Juvenile Arthritis Damage Index for Articular damage (JADI-A), a validated clinical instrument for joint damage.

Results: Elevated serum levels of anti-CII occurred in 3.1%, IgM RF in 3.6%, IgA RF in 3.1% and anti-CCP in 2.6% of the patients. Occurrence of RF and anti-CCP did to some extent overlap, but rarely with anti-CII. The polyarticular and oligoarticular extended categories were overrepresented in patients with two or more autoantibodies. Anti-CII occurred in younger children, usually without overlap with the other autoantibodies and was associated with high levels of C-reactive protein (CRP) early in the disease course. All four autoantibodies were significantly associated with joint damage, but not with active disease at the eight-year follow up.

Conclusions: Anti-CII, anti-CCP, IgA RF and IgM RF detected early in the disease course predicted joint damage when assessed after eight years of disease. The role of anti-CII in JIA should be further studied.

Show MeSH
Related in: MedlinePlus