Lopez-Hoyos M, Ruiz de Alegria C, Blanco R, Crespo J, Peña M, Rodriguez-Valverde V, Martinez-Taboada V M
Immunology Service, Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander, Spain.
Rheumatology (Oxford). 2004 May;43(5):655-7. doi: 10.1093/rheumatology/keh143. Epub 2004 Feb 17.
In a significant number of patients the differential diagnosis between elderly-onset rheumatoid arthritis (EORA) and polymyalgia rheumatica (PMR) is very difficult because of the lack of specific serum markers. Anti-cyclic citrullinated peptide antibodies (anti-CCP Abs) have recently been shown to be highly specific for rheumatoid arthritis (RA). This is the first study addressing the utility of these antibodies in the differential diagnosis between EORA and PMR.
Serum samples from 57 EORA patients and 49 PMR patients were studied for the presence of anti-CCP Abs and rheumatoid factor (RF). As controls, samples from 41 RA patients (age at onset <60 yr) and 24 aged healthy subjects were analysed.
Sixty-five per cent of EORA patients had anti-CCP Abs, whereas none of the PMR patients or the aged healthy subjects was positive for those antibodies. Ten of the EORA patients started with polymyalgic symptoms and two of them were positive for anti-CCP Abs. Interestingly, there was a significant correlation between anti-CCP Abs and RF in EORA but not in young RA patients.
The presence of anti-CCP Abs in a patient with clinical symptoms of PMR must be interpreted as highly suggestive of EORA.
由于缺乏特异性血清标志物，在相当数量的患者中，老年发病的类风湿关节炎（EORA）和风湿性多肌痛（PMR）的鉴别诊断非常困难。抗环瓜氨酸肽抗体（抗CCP抗体）最近被证明对类风湿关节炎（RA）具有高度特异性。这是第一项探讨这些抗体在EORA和PMR鉴别诊断中的效用的研究。
研究了57例EORA患者和49例PMR患者的血清样本中抗CCP抗体和类风湿因子（RF）的存在情况。作为对照，分析了41例RA患者（发病年龄<60岁）和24例老年健康受试者的样本。
65%的EORA患者有抗CCP抗体，而PMR患者或老年健康受试者中无一例该抗体呈阳性。10例EORA患者最初表现为多肌痛症状，其中2例抗CCP抗体呈阳性。有趣的是，EORA患者中抗CCP抗体与RF之间存在显著相关性，而年轻RA患者中则不存在。
PMR临床症状患者中抗CCP抗体的存在必须被解释为高度提示EORA。
