Rheumatology, Allergy and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome "Tor Vergata", Rome, Italy; Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, viale del Policlinico 155, 00161 Rome, Italy.
Rheumatology, Allergy and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome "Tor Vergata", Rome, Italy; Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, viale del Policlinico 155, 00161 Rome, Italy.
Autoimmun Rev. 2016 Jul;15(7):673-83. doi: 10.1016/j.autrev.2016.03.003. Epub 2016 Mar 9.
Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease characterized by extensive synovitis resulting in erosions of articular cartilage and marginal bone with joint destruction. The lack of immunological tolerance in RA represents the first step toward the development of autoimmunity. Susceptible individuals, under the influence of environmental factors, such as tobacco smoke, and silica exposure, develop autoimmune phenomena that result in the presence of autoantibodies. HLA and non-HLA haplotypes play a major role in determining the development of specific autoantibodies differentiating anti-citrullinated antibodies (ACPA)-positive and negative RA patients. Rheumatoid factor (RF) and ACPA are the serological markers for RA, and during the preclinical immunological phase, autoantibody titers increase with a progressive spread of ACPA antigens repertoire. The presence of ACPA represents an independent risk factor for developing RA in patients with undifferentiated arthritis or arthralgia. Moreover, anti-CarP antibodies have been identified in patients with RA as well as in individuals before the onset of clinical symptoms of RA. Several autoantibodies mainly targeting post-translational modified proteins have been investigated as possible biomarkers to improve the early diagnosis, prognosis and response to therapy in RA patients. Psoriatic arthritis (PsA) is distinguished from RA by infrequent positivity for RF and ACPA, together with other distinctive clinical features. Actually, specific autoantibodies have not been described. Recently, anti-CarP antibodies have been reported in sera from PsA patients with active disease. Further investigations on autoantibodies showing high specificity and sensibility as well as relevant correlation with disease severity, progression, and response to therapy are awaited in inflammatory arthritides.
类风湿关节炎（RA）是一种系统性慢性炎症性疾病，其特征为广泛的滑膜炎，导致关节软骨和边缘骨侵蚀，从而发生关节破坏。RA 中缺乏免疫耐受代表了自身免疫发展的第一步。在环境因素（如烟草烟雾和二氧化硅暴露）的影响下，易感个体发生自身免疫现象，导致自身抗体的出现。HLA 和非 HLA 单倍型在决定特定自身抗体的发展中起主要作用，这些自身抗体可区分 ACPA 阳性和阴性 RA 患者。类风湿因子（RF）和 ACPA 是 RA 的血清学标志物，在临床前免疫阶段，随着 ACPA 抗原谱的逐渐扩大，自身抗体滴度增加。ACPA 的存在是未分化关节炎或关节痛患者发生 RA 的独立危险因素。此外，在 RA 患者以及出现 RA 临床症状前的个体中，已经鉴定出抗 CarP 抗体。几种主要针对翻译后修饰蛋白的自身抗体已被作为可能的生物标志物进行研究，以改善 RA 患者的早期诊断、预后和对治疗的反应。银屑病关节炎（PsA）与 RA 的区别在于 RF 和 ACPA 阳性率低，同时还有其他独特的临床特征。实际上，尚未描述特定的自身抗体。最近，在活动期 PsA 患者的血清中报道了抗 CarP 抗体。在炎症性关节炎中，我们期待着对具有高特异性和敏感性的自身抗体以及与疾病严重程度、进展和治疗反应相关的自身抗体进行进一步研究。
