Anti-citrullinated protein antibodies: role in pathogenesis of RA and potential as a diagnostic tool
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REVIEW
Anti-citrullinated protein antibodies: role in pathogenesis of RA and potential as a diagnostic tool Sadaf Moeez • Peter John • Attya Bhatti
Received: 4 April 2012 / Accepted: 15 December 2012 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Rheumatoid arthritis is an autoimmune disorder which involves inflammation of the synovial tissue, leading to synovial proliferation, bone erosion and ultimately joint disability. It is a complex disorder, and the proper etiology is still unknown. Both environmental and genetic factors are responsible for the development of Rheumatoid arthritis. Clinically, the disease is generally diagnosed by the presence of auto-antibodies like Rheumatoid factor. But these are not specifically associated with Rheumatoid arthritis. These are also present in patients with other autoimmune disorders and also in healthy persons. Citrullinated epitopes are shown to be more specific for Rheumatoid arthritis. Citrullination normally occurs in cells undergoing apoptosis, and hence, citrullinated proteins are cleared from body and not encountered by immune system. However, in Rheumatoid arthritis patients, these are not cleared. Anti-citrullinated protein antibodies are detectable in patients at risk of Rheumatoid arthritis long before the onset of the disease. The concentration of which normally increases as the disease progress. Hence, these are important for diagnosis of Rheumatoid arthritis. This review is focused on the importance of anti-citrullinated protein antibodies in disease pathogenesis and its importance in the diagnosis of Rheumatoid arthritis.
S. Moeez P. John (&) A. Bhatti Atta-ur-Rahman School of Applied Biosciences (ASAB), National University of Sciences and Technology (NUST), Sector H-12, Islamabad, Pakistan e-mail: [email protected]; [email protected] A. Bhatti e-mail: [email protected]
Keywords Rheumatoid arthritis Anti-citrullinated protein antibodies (ACPAs) Diagnostic marker Pathogenesis
Introduction Rheumatoid arthritis (RA) is a systematic, inflammatory joints disease, occurs as a chronic inflammatory disorder that is characterized by cartilage destruction [4, 24]. It is related to other autoimmune disease families like insulindependent diabetes mellitus (IDDM) and thyroid diseases [45]. Worldwide, its prevalence is about 0.5–1 % while 0.55–0.75 % of the Pakistani population is affected by RA. Women are three times more susceptible than men with sex ratio of 2–4. Although people at any age are vulnerable to the disease, it is more frequent at the age of 40–50 years. Rheumatoid arthritis is not a life-threatening disease directly, but a patient’s life quality is severely affected by it [39]. Exact etiology of RA is not so far known, but its development depends upon interaction between genetics elements in individual and non-genetic factors. Considerable amount of data have suggested that autoimmunity markers and genetic factors and are very good indicators [20]. Genetic factors like MHC-II (major histocompatibility complex II) and non-MHC a
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