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Rheumatology 2000; 39: 481-489
© 2000 British Society for Rheumatology

Prospective evaluation of the frequency and clinical significance of antineutrophil cytoplasmic and anticardiolipin antibodies in community cases of patients with rheumatoid arthritis

O. Vittecoq1,2,, F. Jouen-Beades2, K. Krzanowska1, I. Bichon-Tauvel3, J. F. Menard4, A. Daragon1,2, D. Gilbert2, F. Tron2 and X. Le Loët1,2

1 Service de Rhumatologie,
2 INSERM U 519 et Institut Fédératif de Recherche Multidisciplinaire sur les Peptides,
3 Collège des Rhumatologues de Haute-Normandie and
4 Unité de Biométrie-Biostatistique, Centre Hospitalier Universitaire de Rouen, 76031 Rouen Cedex, France

Objectives. To evaluate the frequencies of antineutrophil cytoplasmic (ANCA), anticardiolipin (aCLA) and anti-ß2-glycoprotein 1 antibodies (aß2-GP1A) in rheumatoid arthritis (RA) of limited duration in patients recruited primarily from private practitioners (80%), and to attempt to correlate the presence of these antibodies with certain clinical and/or biological criteria.

Patients and methods. Patients (n = 102) with RA evolving for <5 yr (mean 2.2 yr) were recruited. A home evaluation collected clinical data [Ritchie articular index, Health Assessment Questionnaire (HAQ) index, extra-articular manifestations] and blood for biological analyses [C-reactive protein (CRP), rheumatoid factor, ANCA, aCLA, aß2-GP1A]. ANCA were detected by indirect immunofluorescence on neutrophils and their specificity was determined by enzyme-linked immunosorbent assay (ELISA) and confirmed by immunoblotting; aCLA and aß2-GP1A were detected by ELISA.

Results. Patients had mild RA (Ritchie = 11/78 ± 9.6; HAQ = 0.79/3 ± 0.7), probably due to the recruitment procedure. ANCA, aCLA and aß2-GP1A frequencies were 18.5, 7 and 0%, respectively. Titres of ANCA and aCLA were low. A perinuclear ANCA staining pattern was exclusively observed and lactoferrin was shown to be the major antigen recognized. No relationship was found between ANCA and aCLA and/or rheumatoid factor, or any clinical manifestations. ANCA were more common in RA of longer duration (cut-off: 4 yr; P = 0.05) and aCLA were correlated with the CRP level (P = 0.05).

Conclusions. In RA of recent onset, ANCA and aCLA were detected at low titres and frequencies, and were not associated with any clinical manifestations. A longitudinal study is needed to determine whether their early appearance is predictive of subsequent disease severity.

KEY WORDS: Rheumatoid arthritis, ANCA, Anticardiolipin antibodies, Anti-ß2-glycoprotein 1 antibodies, Antilactoferrin antibodies.

Correspondence to: O. Vittecoq.


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