Goldbach-Mansky R, Lee J, McCoy A, Hoxworth J, Yarboro C, Smolen J S, Steiner G, Rosen A, Zhang C, Ménard H A, Zhou Z J, Palosuo T, Van Venrooij W J, Wilder R L, Klippel J H, Schumacher H R, El-Gabalawy H S
Arthritis and Rheumatism Branch, National Institute of Arthritis and Musculoskelatal and Skin Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
Arthritis Res. 2000;2(3):236-43. doi: 10.1186/ar93. Epub 2000 Mar 31.
An inception cohort of 238 patients having peripheral joint synovitis of less than 12 months duration was evaluated clinically and followed prospectively for 1 year to determine the clinical significance of a number of rheumatoid arthritis (RA) associated autoantibodies. Serum samples collected at the time of the initial evaluation were tested for rheumatoid factor (RF) and antibodies to Sa (anti-Sa), RA-33, (pro)filaggrin [antifilaggrin antibody (AFA)], cyclic citrullinated peptide (anti-CCP), calpastatin, and keratin [antikeratin antibody (AKA)]. RF had a sensitivity of 66% and a specificity of 87% for RA. Anti-Sa, AFA, and anti-CCP all had a specificity of more than 90%, but a sensitivity of less than 50% for this diagnosis. Overall, there was a high degree of correlation between AFA, AKA, anti-Sa or anti-CCP, this being highest between anti-Sa and anti-CCP (odds ratio, 13.3; P < 0.001). Of the 101 patients who were positive for at least one of these four autoantibodies, 57% were positive for only one. Finally, anti-SA identified a subset of predominantly male RA patients with severe, erosive disease. Anti-SA, AFA and anti-CCP are all specific for early RA but, overall, have little additional diagnostic value over RF alone. Although these antibodies may preferentially recognize citrullinated antigens, the modest degree of concordance between them in individual patient sera suggests that it is unlikely a single antigen is involved in generating these responses.
对238例病程少于12个月的外周关节滑膜炎患者的起始队列进行了临床评估，并进行了为期1年的前瞻性随访，以确定多种类风湿关节炎（RA）相关自身抗体的临床意义。在初始评估时采集的血清样本检测了类风湿因子（RF）、抗Sa抗体（anti-Sa）、RA-33、（原）丝聚蛋白[抗丝聚蛋白抗体（AFA）]、环瓜氨酸肽（抗CCP）、钙蛋白酶抑制蛋白和角蛋白[抗角蛋白抗体（AKA）]。RF对RA的敏感性为66%，特异性为87%。抗Sa、AFA和抗CCP的特异性均超过90%，但对该诊断的敏感性均低于50%。总体而言，AFA、AKA、抗Sa或抗CCP之间存在高度相关性，抗Sa和抗CCP之间的相关性最高（优势比为13.3；P<0.001）。在这四种自身抗体中至少有一种呈阳性的101例患者中，57%仅有一种呈阳性。最后，抗SA识别出一组以男性为主的重症侵蚀性RA患者。抗SA、AFA和抗CCP对早期RA均具有特异性，但总体而言，相对于单独的RF几乎没有额外的诊断价值。尽管这些抗体可能优先识别瓜氨酸化抗原，但它们在个体患者血清中的一致性程度适中，这表明不太可能是单一抗原参与了这些反应的产生。
