Prevalence and clinical significance of anti-cyclic citrullinated peptide antibodies in juvenile idiopathic arthritis

Abstract

Background: Antibodies against cyclic citrullinated peptide (anti-CCP) are considered to be specific for rheumatoid arthritis (RA).

Objective: To assess the clinical significance of anti-CCP in a cohort of patients with juvenile idiopathic arthritis (JIA).

Methods: Anti-CCP were tested by an enzyme linked immunosorbent assay (ELISA) in serum samples from 109 patients with JIA (30 boys, 79 girls), with a mean age of 8.7 years (range 0.6-20.3) and mean disease duration of 3.6 years (range 3 months to 15.6 years). As control groups, anti-CCP were also tested in sera of 30 healthy children, 25 patients with juvenile onset systemic lupus erythematosus (SLE), and 50 adult patients (30 with RA, 20 with SLE).

Results: Positive anti-CCP values were found in sera of two patients with JIA (2%), one with polyarthritis, and one with oligoarthritis. Statistical analysis showed that anti-CCP were not associated with the presence of antinuclear antibodies, raised erythrocyte sedimentation rate, or erosions. In the control groups, none of the patients with juvenile onset SLE and only one of 20 adults with SLE were positive for anti-CCP, but 19/30 (63%) adults with RA showed anti-CCP positivity.

Conclusions: Anti-CCP can be detected in children with JIA, but are less frequently present than in adults with RA.

Figure 1

The cumulative results of anti-CCP assays in all the patients studied. Serum values of anti-CCP are shown in the group of patients with juvenile idiopathic arthritis (JIA), healthy children, patients with juvenile onset systemic lupus erythematosus (JSLE), rheumatoid arthritis (RA), and adult SLE. The horizontal lines indicate means of pooled data for each group of patients. The dashed line indicates the cut off value.

Figure 2

Anti-CCP values in patients with different subtypes of JIA (polyarticular, oligoarticular, and systemic disease). The horizontal lines indicate means of pooled data for each subtype of JIA. The cut off value is indicated as a horizontal dashed line.