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Open Access Highly Accessed Research article

Antibodies to mutated citrullinated vimentin for diagnosing rheumatoid arthritis in anti-CCP-negative patients and for monitoring infliximab therapy

Pascale Nicaise Roland1*, Sabine Grootenboer Mignot1, Alessandra Bruns2, Margarita Hurtado13, Elisabeth Palazzo2, Gilles Hayem2, Philippe Dieudé2, Olivier Meyer2 and Sylvie Chollet Martin13

Author Affiliations

1 Immunology and Haematology Department, Bichat-Claude Bernard Teaching Hospital, AP-HP, 46, rue H Huchard 75877 Paris Cedex 18, France

2 Rheumatology Department, Bichat-Claude Bernard Teaching Hospital, AP-HP, 46 rue H Huchard 75877 Paris Cedex 18, France

3 Inserm IFR 141, UMR756, Paris-South 11 University, 5 rue JB Clement 92296 Chatenay-Malabry Cedex, France

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Arthritis Research & Therapy 2008, 10:R142  doi:10.1186/ar2570

Published: 10 December 2008

Abstract

Introduction

Antibodies against cyclic citrullinated peptides (CCPs) are useful for diagnosing rheumatoid arthritis (RA). Antibodies to mutated citrullinated vimentin (MCV) were described recently in RA. The aims of this study were to evaluate the usefulness of anti-MCV for diagnosing RA in anti-CCP-negative patients and to monitor anti-MCV titres during infliximab therapy for RA.

Methods

We studied two groups of RA patients, one with (n = 80) and one without (n = 76) anti-CCP antibodies. The specificity of anti-MCV was evaluated by investigating 50 healthy controls and 158 patients with other rheumatic diseases (51 psoriatic rheumatism, 58 primary Sjögren syndrome, and 49 ankylosis spondylitis). Serum anti-MCV and anti-CCP titres were measured in 23 patients after 6, 12, 18, and 24 months of infliximab treatment. Anti-CCP2 and anti-MCV levels were assayed using a commercial enzyme-linked immunosorbent assay. IgM rheumatoid factor was determined by nephelometry.

Results

In accordance with the cutoff values recommended by the manufacturer, the specificity of anti-MCV antibodies was 90.9%. We adjusted the cutoff values to obtain the same specificity as that of anti-CCP antibodies (94.2%). With this optimal cutoff, anti-MCV antibodies were found in 11.8% (9/76) of RA patients without anti-CCP, and similarly, anti-CCP antibodies were found in 11.2% (9/80) of RA patients without anti-MCV. Anti-MCV antibodies were positive in 6 patients who tested negative for both anti-CCP and rheumatoid factor. Anti-MCV titres were significantly decreased after 18 and 24 months of infliximab therapy compared with baseline (P < 0.01) as a significant decrease of anti-CCP levels occurred only at 24 months (P < 0.04). Moreover, an anti-MCV decrease was significantly associated with DAS28 (disease activity score using 28 joint counts) improvements 12 months into therapy.

Conclusions

Our results suggest that anti-MCV antibodies may be valuable for diagnosing RA in anti-CCP-negative patients without replacing them as an equivalent number of anti-CCP-positive RA patients test negative for anti-MCV. Moreover, anti-MCV antibodies could be useful for monitoring the effects of infliximab therapy.