Department of Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
J Rheumatol. 2012 Oct;39(10):1934-41. doi: 10.3899/jrheum.110984. Epub 2012 Aug 15.
Rheumatic diseases cause significant morbidity within American Indian populations. Clinical disease presentations, as well as historically associated autoantibodies, are not always useful in making a rapid diagnosis or assessing prognosis. The purpose of our study was to identify autoantibody associations among Oklahoma tribal populations with rheumatic disease.
Oklahoma tribal members (110 patients with rheumatic disease and 110 controls) were enrolled at tribal-based clinics. Patients with rheumatic disease (suspected or confirmed diagnosis) were assessed by a rheumatologist for clinical features, disease criteria, and activity measures. Blood samples were collected and tested for common rheumatic disease autoantibodies [antinuclear antibody (ANA), anti-cyclic citrullinated peptide antibodies (anti-CCP), rheumatoid factor (RF), anti-Ro, anti-La, anti-Sm, anti-nRNP, anti-ribosomal P, anti-dsDNA, and anticardiolipins].
In patients with suspected systemic rheumatic diseases, 72% satisfied American College of Rheumatology classification criteria: 40 (36%) had rheumatoid arthritis (RA), 16 (15%) systemic lupus erythematosus, 8 (7%) scleroderma, 8 (7%) osteoarthritis, 4 (4%) fibromyalgia, 2 (2%) seronegative spondyloarthropathy, 1 Sjögren's syndrome, and 1 sarcoidosis. Compared to controls, RA patient sera were more likely to contain anti-CCP (55% vs 2%; p < 0.001) or RF IgM antibodies (57% vs 10%; p < 0.001); however, the difference was greater for anti-CCP. Anti-CCP positivity conferred higher disease activity scores (DAS28 5.6 vs 4.45; p = 0.021) while RF positivity did not (DAS28 5.36 vs 4.64; p = 0.15). Anticardiolipin antibodies (25% of rheumatic disease patients vs 10% of controls; p = 0.0022) and ANA (63% vs 21%; p < 0.0001) were more common in rheumatic disease patients.
Anti-CCP may serve as a more specific RA biomarker in American Indian patients, while the clinical significance of increased frequency of anticardiolipin antibodies needs further evaluation.
风湿性疾病在美国印第安人群中造成了显著的发病率。临床疾病表现以及历史上相关的自身抗体，并不总是有助于快速诊断或评估预后。我们研究的目的是确定俄克拉荷马部落人群中与风湿性疾病相关的自身抗体关联。
在部落诊所招募了俄克拉荷马部落成员（110 名风湿性疾病患者和 110 名对照者）。风湿性疾病患者（疑似或确诊诊断）由风湿病专家评估临床特征、疾病标准和活动度测量。采集血液样本并检测常见的风湿性疾病自身抗体[抗核抗体（ANA）、抗环瓜氨酸肽抗体（抗-CCP）、类风湿因子（RF）、抗 Ro、抗 La、抗 Sm、抗 nRNP、抗核糖体 P、抗 dsDNA 和抗心磷脂]。
在疑似系统性风湿性疾病患者中，72%符合美国风湿病学会分类标准：40 例（36%）为类风湿关节炎（RA），16 例（15%）为系统性红斑狼疮，8 例（7%）为硬皮病，8 例（7%）为骨关节炎，4 例（4%）为纤维肌痛，2 例（2%）为血清阴性脊柱关节病，1 例干燥综合征，1 例结节病。与对照组相比，RA 患者血清更可能含有抗-CCP（55%比 2%；p < 0.001）或 RF IgM 抗体（57%比 10%；p < 0.001）；然而，抗-CCP 的差异更大。抗-CCP 阳性与更高的疾病活动评分（DAS28 5.6 比 4.45；p = 0.021）相关，而 RF 阳性则无相关性（DAS28 5.36 比 4.64；p = 0.15）。抗心磷脂抗体（风湿性疾病患者的 25%比对照组的 10%；p = 0.0022）和 ANA（风湿性疾病患者的 63%比对照组的 21%；p < 0.0001）在风湿性疾病患者中更为常见。
抗-CCP 可能是美国印第安患者中更特异的 RA 生物标志物，而增加抗心磷脂抗体的频率的临床意义需要进一步评估。
