Abstract
Anti-carbamylated protein (anti-CarP) antibodies are promising biomarkers in rheumatoid arthritis (RA), although their significance in seronegative disease (SNRA) remains uncertain. To assess the influence of anti-CarP antibodies on disease activity and erosive joint damage in SNRA patients. In RA patients, rheumatoid factor (RF), anti-citrullinated protein antibodies, and anti-CarP antibodies were measured. Disease activity was assessed using DAS28-CRP and SDAI indices, while musculoskeletal ultrasound identified bone erosions. A total of 77 patients were enrolled, comprising 49 with seropositive RA (SPRA) and 28 with SNRA. Notably, 28% of SPRA and 10% of SNRA patients were positive to anti-CarP antibodies. Anti-CarP-positive patients exhibited elevated C-reactive protein (median 10.6, interquartile range 4.6–20.0 vs. 3.4, 1.7–9.9 mg/L; p = 0.005), erythrocyte sedimentation rate (34, 19–46 vs. 16, 7–25 mm/h; p = 0.002), DAS28-CRP (3.2, 2.6–4.2 vs. 2.6, 1.9–3.5; p = 0.048), and SDAI (19.9, 6.3–32.1 vs. 10.9, 5.5–18.1; p = 0.034) indices. Multivariate analysis revealed RF positivity as the sole predictor for anti-CarP antibodies (odds ratio [OR] = 5.9). Musculoskeletal ultrasound revealed bone erosions in 36% of RA patients; 35% among anti-CarP-negative patients and 40% among anti-CarP-positive patients. Notably, RF presence (OR = 44.3) and DAS28-CRP index (OR = 2.4) emerged as predictors of musculoskeletal ultrasound-confirmed erosive joint disease. Anti-CarP antibodies are detected at similar frequencies among both SPRA and SNRA patients. While associated with increased disease activity, these antibodies did not correlate with increased erosive joint damage.
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All authors contributed substantially to the study conception and design of this work. Data collection was performed by NC-B, ABB-M, TV, and ACM-G. Laboratory procedures were performed by AH-D and VJ-R. Ultrasound studies were performed by CS-F and CP. Statistical analysis was performed by LMA-G. The first draft of the manuscript was written by LMA-G and all authors revised it critically for important intellectual content. This project was coordinated by LMA-G, CP, and LHS. The final manuscript was read and approved by all authors for publication. All authors take full responsibility for the integrity and accuracy of all aspects of the work.
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This study adhered to the principles outlined in the Declaration of Helsinki and local regulations. The research protocol was approved by the local ethics committee (Comité de Ética del Instituto Nacional de Cardiología Ignacio Chávez; protocol #16-960). All participating patients provided informed consent, granting authorization for the utilization of their clinical and laboratory data for research purposes.
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Amezcua-Guerra, L.M., Carbonell-Bobadilla, N., Soto-Fajardo, C. et al. Influence of anti-carbamylated protein antibodies on disease activity and joint erosions in seronegative and seropositive rheumatoid arthritis. Rheumatol Int 43, 2245–2250 (2023). https://doi.org/10.1007/s00296-023-05445-9
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DOI: https://doi.org/10.1007/s00296-023-05445-9