Diagnostic utility of, and influence of tobacco usage and genetic predisposition on, immunoglobulin A, rheumatoid factor and anti-citrullinated peptide auto-antibodies in South African rheumatoid arthritis patients

• Published in: African health sciences Vol. 18; no. 2; pp. 295 - 303
• Main Authors: Meyer, Pieter, Ally, Mahmood, Hodkinson, Bridget, Anderson, Ronald, Tikly, Mohammed
• Format: Journal Article
• Language: English
• Published: Uganda Makerere University Medical School 01.06.2018; Makerere Medical School
• Subjects: Adolescent; Aged; anti-citrullinated peptide; Anti-Citrullinated Protein Antibodies - blood; Anti-Citrullinated Protein Antibodies - immunology; Arthritis, Rheumatoid - blood; Arthritis, Rheumatoid - epidemiology; Arthritis, Rheumatoid - genetics; Arthritis, Rheumatoid - immunology; Autoantibodies - blood; Autoantibodies - immunology; Case-Control Studies; Cohort Studies; Female; genetic predisposition; Genetic Predisposition to Disease - genetics; Humans; Immunoenzyme Techniques; immunoglobulin A; Immunoglobulin A - blood; Immunoglobulin A - immunology; Immunoglobulin G - blood; Immunoglobulin G - immunology; Male; Middle Aged; Nephelometry and Turbidimetry; Predictive Value of Tests; Prevalence; rheumatoid arthritis patients; Rheumatoid Factor - blood; Rheumatoid Factor - immunology; Sensitivity and Specificity; Severity of Illness Index; Smoking - immunology; South Africa; South Africa - epidemiology; Tobacco usage; Tobacco Use - adverse effects; Tobacco Use - epidemiology; Young Adult; South Africa; genetic predisposition; immunoglobulin A; South Africa; rheumatoid arthritis patients; Tobacco usage; anti-citrullinated peptide
• ISSN: 1680-6905; 1729-0503; 1680-6905; 1729-0503
• DOI: 10.4314/ahs.v18i2.14

Background: The immunoglobulin A isotypes of anti-cyclic citrullinated peptide antibodies (ACPA) and rheumatoid factor (RF) are associated with disease severity and progression in Caucasian rheumatoid arthritis (RA) patients, as well as with genetic predisposition and tobacco use. Objectives: To compare levels of ACPA-IgA and RF-IgA with those of ACPA-IgG and cRF in a cohort of black South African RA patients and healthy controls.To investigate the relationship between IGA autoantibodies and disease severity, genetic predisposition and tobacco use Methods: RF-IgA and ACPA-IgA were determined in a cohort of predominantly black South African RA patients (n=75) in relation to serodiagnostic and prognostic potential, as well as tobacco use and genetic predisposition. Healthy control subjects were included to determine sensitivity, specificity and predictive values. ACPA-IgG/IgA and RF-IgA were determined by enzyme immunoassay and hs-CRP and cRF by nephelometry. Cotinine levels were determined by ELISA. Results: The frequencies of ACPA-IgA and RF-IgA were 31% and 88% respectively compared to 88% for both types of traditional autoantibody procedures. ACPA-IgA was significantly higher (p=0.007) in patients with short disease duration, while linear regression analysis revealed a positive relationship with baseline disease activity scores. Levels of ACPA-IgG and ACPA-IgA were significantly higher in tobacco users who carried the HLA shared epitope. Conclusion: Although lacking in serodiagnostic superiority over cRF and ACPA-IgG, inclusion of RF-IgA and ACPA-IgA in autoantibody panels may provide insights into disease pathogenesis, interactions between tobacco usage and HLA genotype in the production of potentially disease-triggering ACPA-IgA antibodies.