Abstract:
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.
