Oliveira Rene Donizeti, Junta Cristina Maria, Oliveira Fabíola Reis, Silva Lucienir Maria, Donadi Eduardo Antonio, Louzada-Junior Paulo
Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
Clin Rev Allergy Immunol. 2008 Feb;34(1):32-5. doi: 10.1007/s12016-007-8017-2.
The events involved in the pathogenesis of rheumatoid arthritis (RA) still remain unclear, but certainly the etiology is multifactorial. Shared epitope (SE) of HLADRbeta1 is the most important genetic risk factor. Environmental risk factors are less understood. Smoking is a candidate, associated with the rising of citrullinated cyclic peptide antibodies (anti-CCP). Anti-CCP antibodies are highly specific for RA. In this study, we investigated whether the association between anti-CCP production and smoking was influenced by carriage of SE in a highly miscegenated population of patients with RA. One hundred Brazilian patients were inquired about cigarette smoking. For all of them, DNA for HLA typing and serum to anti-CCP antibodies quantification were obtained. Forty-two were smokers and 58 were nonsmokers. The SE was present in 61 patients and the anti-CCP was positive in 71 patients. We found that, among smokers, 25 were SE-positive, 22 presented with anti-CCP and 3 without anti-CCP, and 17 were SE-negative, 9 presented with anti-CCP and 8 without anti-CCP (OR 6.5, 95% CI 1.40 to 30.20). These results suggest that environmental factors contribute to the raising of anti-CCP in individuals with HLA background to RA, smoking being a strong candidate.
类风湿关节炎（RA）发病机制中涉及的事件仍不清楚，但病因肯定是多因素的。HLADRβ1的共享表位（SE）是最重要的遗传风险因素。环境风险因素的了解较少。吸烟是一个候选因素，与瓜氨酸化环肽抗体（抗CCP）的升高有关。抗CCP抗体对RA具有高度特异性。在本研究中，我们调查了在高度混血的RA患者群体中，抗CCP产生与吸烟之间的关联是否受SE携带情况的影响。询问了100名巴西患者的吸烟情况。为他们所有人获取了用于HLA分型的DNA和用于抗CCP抗体定量的血清。42人是吸烟者，58人是非吸烟者。61名患者存在SE，71名患者抗CCP呈阳性。我们发现，在吸烟者中，25人SE阳性，22人抗CCP阳性，3人抗CCP阴性，17人SE阴性，9人抗CCP阳性，8人抗CCP阴性（比值比6.5，95%置信区间1.40至30.20）。这些结果表明，环境因素促使具有RA HLA背景的个体中抗CCP升高，吸烟是一个有力的候选因素。
