Hop, H. (Hilde) (2014) Reumatoïde Artritis en Inflammatoire Darmziekten. Is inflammatie van de darmmucosa een trigger voor de aanmaak van anti-citrullinated antibodies? thesis, Medicine.
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Abstract
Introduction: presence of anti-citrullinated peptide antibodies (ACPAs) is very specific for rheumatoid arthritis (RA). ACPAs can be detected several years before the onset of clinical symptoms and are thought to have a pathogenic role. It’s unclear where and when the ACPA production starts. Chronic mucosal inflammation is considered as a potential trigger of anticitrulline immunity. Moreover, it’s suggested that the gut micro biome is involved in induction of (auto) immunity. Citrullinated proteins have been demonstrated in intestinal tissue of patients with inflammatory bowel diseases (IBD). Furthermore, musculoskeletal manifestations are frequently seen in IBD patients. However, presence of low levels of ACPAs hasn’t been studied yet. Goal: the first goal was to assess the prevalence of low ACPA levels in patients with IBD. The second goal was to determine which factors contribute to ACPA production. The third goal was to compare the prevalence and development of joint complications in ACPA positive and ACPA negative patients Materials en method: in this study 560 patients were included; 232 had ulcerative colitis (UC) and 328 had Crohn’s disease (CD). Baseline characteristics were obtained from medical records. ACPA levels of 397 patients were measured using an anti- CCP enzyme- linked immunosorbent assay (ELISA). The cut- off value for ACPA was 2 u/mL. Characteristics of ACPA- positive patients were compared with 1:2 diagnose, sex and age matched ACPA negative patients. Development of arthritic manifestations in ACPA positive (median follow up of 16 months) and in ACPA negative patients (median follow up of 24 months) was evaluated. Results: ACPA ≥ 2 u/mL was measured in 65 of 397 patients. Maximum level was 13,6 u/mL. The proportion of antibody positivity was higher in CD- patients, although not significant. There was no significant difference in duration of disease, disease activity, smoking behavior and medication use among ACPA positive and ACPA negative patients. At baseline more arthralgia was observed in ACPA- positive patients, although not significant. During follow up, more cases of new arthralgia and even one case of arthritis were found in ACPA- negative patients. Conclusion: the present findings support the hypothesis that inflammation of intestinal mucosa triggers ACPA- production, but the clinical relevance of the phenomenon is unclear.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Brouwer, Mevr. Dr. E. and Dijkstra, Dhr. Prof. Dr. G. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:05 |
| Last Modified: | 25 Jun 2020 11:05 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2513 |
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