Pecani Arbi, Alessandri Cristiano, Spinelli Francesca Romana, Priori Roberta, Riccieri Valeria, Di Franco Manuela, Ceccarelli Fulvia, Colasanti Tania, Pendolino Monica, Mancini Riccardo, Truglia Simona, Barbati Cristiana, Vomero Marta, Sabatinelli Danilo, Morello Francesca, Valesini Guido, Conti Fabrizio
Dipartimento di Medicina Interna e Specialità Mediche, Reumatologia, Sapienza Università di Roma, Rome, Italy.
Arthritis Res Ther. 2016 Nov 25;18(1):276. doi: 10.1186/s13075-016-1173-0.
Antibodies against carbamylated proteins (anti-CarP) have been recently identified in the sera of patients with rheumatoid arthritis (RA). The objective of the study was to evaluate the prevalence, sensitivity and specificity of anti-CarP compared to anti-citrullinated peptide antibodies (ACPA) and rheumatoid factor (RF), replicating the existing data in a large cohort of Italian patients with RA and extending the evaluation to other autoimmune rheumatic diseases (AIRDs).
Serum samples (n = 607) from 309 patients with RA, 200 disease controls and 98 normal healthy subjects (NHS) were evaluated. Anti-CarP were detected using carbamylated fetal calf serum as the antigen. ACPAs were detected using second-generation ELISA and IgM RF was assessed as part of routine analysis.
Anti-CarP antibodies were detected in 117 patients with RA (34.4%), ACPA in 190 patients (61.4%) and RF in 202 patients (65.3%). Two (2.04%) of the NHS were positive for anti-CarP, one NHS (1.02%) was positive for ACPA and three NHS were positive for RF (3.06%). Among disease controls, anti-CarP antibodies were detected in 33 patients (16.5%), ACPA in 29 patients (14.5%) and RF in 64 patients (32%). In particular, 16.8% of patients with systemic lupus erythematosus and 31.1% of patients with Sjögren syndrome were positive for anti-CarP. The sensitivity of anti-CarP, ACPA and RF was 46.8%, 61.8% and 64.4%, respectively and specificity was 91.95%, 89.93% and 76.51%, respectively.
The present study extends the knowledge of anti-CarP antibodies, confirming previous data on the diagnostic accuracy of anti-CarP in RA in a large cohort of Italian patients. Anti-CarP antibodies demonstrated relatively low sensitivity and slightly higher specificity compared to ACPA and RF. Even if predominantly present in RA, anti-CarP was detected in a variable percentage of patients with other autoimmune rheumatic diseases and their generation could be attributed to the inflammatory status; the clinical relevance of anti-CarP antibodies in these latter patients should be further determined.
近期在类风湿关节炎（RA）患者血清中发现了抗氨甲酰化蛋白抗体（anti-CarP）。本研究的目的是评估anti-CarP与抗瓜氨酸化肽抗体（ACPA）和类风湿因子（RF）相比的患病率、敏感性和特异性，在一大群意大利RA患者中复制现有数据，并将评估扩展至其他自身免疫性风湿性疾病（AIRD）。
评估了309例RA患者、200例疾病对照和98例正常健康受试者（NHS）的血清样本（n = 607）。以氨甲酰化胎牛血清作为抗原检测anti-CarP。使用第二代酶联免疫吸附测定（ELISA）检测ACPA，并将IgM RF作为常规分析的一部分进行评估。
117例RA患者（34.4%）检测到anti-CarP抗体，190例患者（61.4%）检测到ACPA，202例患者（65.3%）检测到RF。2例（2.04%）NHS的anti-CarP呈阳性，1例NHS（1.02%）的ACPA呈阳性，3例NHS的RF呈阳性（3.06%）。在疾病对照中，33例患者（16.5%）检测到anti-CarP抗体，29例患者（14.5%）检测到ACPA，64例患者（32%）检测到RF。特别是，16.8%的系统性红斑狼疮患者和31.1%的干燥综合征患者anti-CarP呈阳性。anti-CarP、ACPA和RF的敏感性分别为46.8%、61.8%和64.4%，特异性分别为91.95%、89.93%和76.51%。
本研究扩展了对抗氨甲酰化蛋白抗体的认识，在一大群意大利患者中证实了先前关于anti-CarP在RA诊断准确性的数据。与ACPA和RF相比，anti-CarP抗体显示出相对较低的敏感性和略高的特异性。即使主要存在于RA中，在其他自身免疫性风湿性疾病患者中也检测到了不同比例的anti-CarP，其产生可能归因于炎症状态；应进一步确定anti-CarP抗体在这些患者中的临床相关性。
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