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Titer-Dependent Effect of Anti-Citrullinated Protein Antibodies On Systemic Bone Mass in Rheumatoid Arthritis Patients

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Abstract

Bone loss in rheumatoid arthritis (RA) is a key feature both local and systemic. Anti-citrullinated protein antibodies (ACPA) have recently been found to directly induce differentiation and activation of osteoclasts and therefore contribute to periarticular bone loss. The aim of this study was to analyze the effect of ACPA on systemic bone mineral density (BMD) in patients with established RA. This is a cross-sectional study with a single-center RA population. BMD was measured with Dual X-ray absorptiometry at lumbar and femoral sites. ACPA were measured by EIA. Multivariate analysis was performed adjusting for the main confounding variables. One hundred twenty-seven RA patients were enrolled. In univariate analysis, ACPA-positive patients showed lower BMD Z-score (SD below the age- and gender-matched mean reference value) at femoral sites (p < 0.01). A negative correlation between ACPA titer and BMD Z-score at all sites was observed (p < 0.01). The multivariate analysis adjusted for the main confounding variables confirmed the negative effect of ACPA at femoral sites (p < 0.05), but not at lumbar spine BMD. No significant effect of rheumatoid factor has been observed. ACPA have a negative titer-dependent effect on BMD at femoral sites, mainly constituted by cortical bone. ACPA-positive patients, especially if at high titer, should undergo bone investigations and be treated with bone protecting agents. Disease-modifying anti-rheumatic drugs lowering ACPA titer might have positive effects on systemic bone mass.

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Acknowledgements

The authors thank Sara Rossini who provided editorial assistance.

Funding

No funding was received to carry out this study.

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Authors and Affiliations

  1. Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy

    Giovanni Orsolini, Cristian Caimmi, Ombretta Viapiana, Luca Idolazzi, Elena Fracassi, Davide Gatti, Giovanni Adami & Maurizio Rossini

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  1. Giovanni Orsolini
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  2. Cristian Caimmi
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  3. Ombretta Viapiana
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  4. Luca Idolazzi
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  7. Giovanni Adami
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  8. Maurizio Rossini
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Correspondence to Giovanni Orsolini.

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Conflict of interest

Giovanni Orsolini, Cristian Caimmi, Ombretta Viapiana, Luca Idolazzi, Elena Fracassi, Davide Gatti, Giovanni Adami, and Maurizio Rossini have no potential conflict of interest to disclose.

Ethical Approval

The study was performed according to the Helsinki declaration and approved by Ethics Committee of Provinces of Verona and Rovigo with protocol number 1806.

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All patients provided written informed consent for their participation to the study.

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Orsolini, G., Caimmi, C., Viapiana, O. et al. Titer-Dependent Effect of Anti-Citrullinated Protein Antibodies On Systemic Bone Mass in Rheumatoid Arthritis Patients. Calcif Tissue Int 101, 17–23 (2017). https://doi.org/10.1007/s00223-017-0253-8

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  • DOI: https://doi.org/10.1007/s00223-017-0253-8

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