Evaluation of third generation anti-CCP antibodies in the diagnosis of rheumatoid arthritis from undifferentiated polyarthritis after 4 years of follow-up.

OBJECTIVES: Rheumatoid arthritis (RA) is a complex pathology to identify at an early stage. A large number of patients with recent onset polyarthritis (ROP) do not usually fulfil the ACR criteria for diagnosis of the disease and are classified as having undifferentiated polyarthritis. The aim of this study is to verify with certainty the diagnosis of patients whose illness has not been classified after four years of follow-up, and correlate their actual status with the levels of anti-cyclic citrullinated peptide (anti-CCP) antibodies and rheumatoid factor (RF) found. METHODS: After one year of follow-up, 56 patients from a total of 322, included from January 2002 in the ROP Unit, did not meet ACR criteria for any rheumatic disease. The anti-CCP antibodies and RF levels were determined in the initial clinical assessment. RESULTS: After four years of follow-up, 12 new diagnoses were made in the 56 patients with undifferentiated polyarthritis: 3 seronegative RA, 8 seropositive RA and 1 psoriatic arthritis. The anti-CCP antibodies levels were positive for 5 of these 12 patients (median anti-CCP 228.6 U/mL), and all were RF positive. Six of the 7 anti-CCP antibodies negative patients were diagnosed of RA (3 seropositive and 3 seronegative for RF) and 1 was diagnosed of psoriatic arthritis (anti-CCP antibodies negative and RF positive). Forty-four patients still displayed undifferentiated polyarthritis and were RF negative. CONCLUSION: A positive result for RF and anti-CCP antibodies in patients who do not meet the ACR diagnostic criteria could be a useful indicator of the presence of future RA.

[Antiribosomal antibodies and the neurological manifestations in systemic lupus erythematosus]. / Anticuerpos antirribosómicos y manifestaciones neurológicas en el lupus eritematoso sistémico.

BACKGROUND: The possible positive correlation between the presence of antiribosomic antibodies and neurologic and neuropsychiatric manifestations in patients with systemic lupus erythematosus, cited in the literature, was analyzed. METHODS: Neurological involvement (current or previous) was evaluated in 71 successive patients. The anti-ENA antibodies (extractable nuclear antigens) were studied with special attention to the antiribosomic antibodies by: a) indirect immunofluorescence (IFI) on triple rat substrate, Hep2 and Crithidia luciliae; b) counter immunoelectrophoresis (CIE); c) double immunodiffusion (DI), and d) Western blot (WB) in the Molt-4 cell line. The statistical study was performed by the Fisher exact test. RESULTS: RibosomAL dyeing was observed in only 2 patients by IFI on triple rat substrate and HEp2. With CIE and DI, 14 patients (20%) were anti-ENA positive. Detectable bands were obtained with WB in 47 patients (66%) with 9 corresponding to antiribosomic antibodies. No statistical differences were found (p > 0.3) in relation with the presence of antirobosomic antibodies in particular and anti-ENA in general, between the groups with and without neurologic involvement. CONCLUSIONS: No relation was observed between antiribosomic antibodies and neurolupus by determinations of anti-ENA antibodies by Western blot (superior method--p < 0.0001--to direct immunofluorescence, counter immunoelectrophoresis and double immunodiffusion in the comparative study of sensitivity.