Anti-cyclic citrullinated peptide antibodies in primary Sjögren syndrome may be associated with non-erosive synovitis

Fabiola Atzeni , Piercarlo Sarzi-Puttini , Nicola Lama , Eleonora Bonacci , Francesca Bobbio-Pallavicini , Carlomaurizio Montecucco and Roberto Caporali

Arthritis Research & Therapy 2008, 10:R51doi:10.1186/ar2420


Published:	7 May 2008

Abstract (provisional)

Background

To investigate the prevalence of cyclic citrullinated peptide (anti-CCP) antibodies in patients with primary Sjogren's syndrome (pSS), and their correlations with clinical and laboratory data.

Methods

We analysed the clinical and serological data of 155 consecutive patients with pSS; among these, 14 were excluded due to fulfillment of American College of Rheumatology classificative criteria for Rheumatoid Arthritis . So, 141 patients (27 males and 114 females; mean age 48 years, range 39-60) were clinically assessed for the presence of synovitis (objective swelling of one or more joints) and extra-glandular involvement. The anti-CCP antibodies were tested using a commercially available second-generation enzyme-linked immunosorbent assay (ELISA); IgM rheumatoid factor (RF) was determined by nephelometry.

Results

Fourteen patients (9.9%) had moderate to high level anti-CCP levels, and 94 (66.7%) were positive for RF. Eighty-one (57.4%) showed extra-glandular involvement, and 44 (31.2%) had synovitis without any radiographic signs of erosion. There was a close correlation between the presence of anti-CCP and synovitis (p<0.001), but no association between anti-CCP and extra-glandular involvement (p=0.77). Multivariate analysis confirmed the association between anti-CCP and an increased prevalence of synovitis (prevalence odds ratio for positive vs negative anti-CCP status 7.611; 95% CI 1.475-74.870; P=0.010).

Conclusions

Only a minority of pSS patients are anti-CCP positive, which seems to be closely associated with the prevalence of synovitis. Anti-CCP positivity in pSS patients may therefore be a predictor of future progress to RA, or an expression of the inflammatory process of synovial tissue.