Anti-cyclic citrullinated peptide antibodies in psoriatic arthritis – cross-sectional study and literature review

Abstract Rationale: Anti-CCP antibodies are detectable not only in rheumatoid arthritis (RA), but also in psoriatic arthritis (PsA). It is possible those anti-CCP antibodies are associated with features of PsA and that these auto-antibodies are useful in distinguishing PsA from RA. Objective: to evaluate the prevalence and the associations of anti-CCP antibodies in PsA patients; to evaluate the usefulness of anti-CCP antibodies in distinguishing PsA from RA. Methods and Results: The inquiry was designed as a cross-sectional study of 41 PsA patients, 139 RA patients and 147 normal subjects, which recorded demographic data, disease activity and serology: rheumatoid factor (RF), anti-CCP antibodies. Five PsA patients (12.2%) were anti-CCP positive. Compared to anti-CCP negative PsA patients, anti-CCP positive PsA patients had a more frequently a polyarticular disease pattern (p = 0.005), they were more frequently treated with biologics (p = 0.015) and less frequently with classic disease-modifying drugs (p < 0.001). An optimal positive cutoff value for anti-CCP titer was determined (11.6 U/mL), over which it is highly probable that a known PsA patient actually has RA and psoriasis. Discussion: The more aggressive the disease of anti-CCP positive PsA patients indicates the need of a more intensive management regarding anti-rheumatic treatment and follow-up. Anti-CCP antibodies can be a useful tool in differentiating PsA from RA, especially in RA-like forms of PsA, which present no elements pertaining to spondyloarthropathies. Abbreviations: anti-CCP - anti-cyclic citrullinated peptide antibodies; ACR - America College of Rheumatology; CRP - C-reactive protein; CASPAR - The Classification Criteria for Psoriatic Arthritis; DMARD – disease modifying anti-rheumatic drug; EULAR - European League against Rheumatism; ELISA - enzyme-linked immunosorbent assay; ESR - erythrocyte sedimentation rate; HLA – human leukocyte antigen; PsA - psoriatic arthritis; RA - rheumatoid arthritis; RF - rheumatoid factor; ROC - receiver operating characteristic.