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Original Article
DOI: 10.1016/j.reumae.2017.08.010
Available online 27 July 2019
Association of the shared epitope, smoking and the interaction between the two with the presence of autoantibodies (anti-CCP and FR) in patients with rheumatoid arthritis in a hospital in Seville, Spain
Asociación del epítopo compartido, el tabaquismo y la interacción entre ambos con la presencia de autoanticuerpos (anti-PCC y FR) en pacientes con artritis reumatoide en un hospital de Sevilla, España
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José Luis García de Veas Silvaa,
Corresponding author
Jose6@outlook.com

Corresponding author.
, Concepción González Rodríguezb, Blanca Hernández Cruzc
a Laboratorio de Inmunología, Unidad de Laboratorios Clínicos, Hospital Campus de la Salud, Granada, Spain
b Laboratorio de Autoinmunidad, Unidad de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain
c Consulta de Artritis Precoz, Unidad de Reumatología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Tables (4)
Table 1. Patient characteristics at baseline visit.
Table 2. Factors associated with anti-CCP antibodies in patients with rheumatoid arthritis.
Table 3. Factors associated with rheumatoid factor positivity in patients with rheumatoid arthritis.
Table 4. Multivariate ordinal logistic regression model of the variables that independently influence the presence of positive anti-CCP antibodies in patients with rheumatoid arthritis.
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Abstract
Objectives

To evaluate the association of shared epitope, smoking and their interaction on the presence of autoantibodies (anti-cyclic citrullinated peptide [CCP] antibodies and rheumatoid factor) in patients with rheumatoid arthritis in our geographical area.

Methods

A descriptive and cross-sectional study was carried out in a cohort of 106 patients diagnosed with RA. Odds ratios (OR) for antibody development were calculated for shared epitope, tobacco exposure and smoking dose. Statistical analysis was performed with univariate and multivariate statistics using ordinal logistic regression. Odds ratios were calculated with 95% confidence interval (95% CI) and a value of P<.05 was considered significant.

Results

In univariate analysis, shared epitope (OR=2.68; 95% CI: 1.11–6.46), tobacco exposure (OR=2.79; 95% CI: 1.12–6.97) and heavy smoker (>20packs/year) (OR=8.93; 95% CI: 1.95–40.82) were associated with the presence of anti-CCP antibodies. For rheumatoid factor, the association was only significant for tobacco exposure (OR=3.89; 95% CI: 1.06–14.28) and smoking dose (OR=8.33; 95% CI: 1.05–66.22). By ordinal logistic regression analysis, an association with high titres of anti-CCP (>200U/mL) was identified with South American mestizos, patients with homozygous shared epitope, positive FR and heavy smokers.

Conclusions

Being a South American mestizo, having a shared epitope, rheumatoid factor positivity and a smoking dose >20packs/year are independent risk factors for the development of rheumatoid arthritis with a high titre of anti-CCP (>200U/mL). In shared epitope-positive rheumatoid arthritis patients, the intensity of smoking is more strongly associated than tobacco exposure with an increased risk of positive anti-CCP.

Keywords:
Rheumatoid arthritis
Smoking
Shared epitope
Autoantibodies
Resumen
Objetivo

Evaluar la asociación del epítopo compartido, el tabaquismo y la interacción entre ambos sobre la presencia de autoanticuerpos (antipéptidos cíclicos citrulinados [anti-PCC] y factor reumatoide) en pacientes con artritis reumatoide en nuestra área geográfica.

Métodos

Estudio descriptivo y transversal realizado en una cohorte de 106 pacientes diagnosticados de artritis reumatoide. Análisis estadístico univariante y multivariante mediante regresión logística ordinal. Se calcularon odds ratios (OR) con un intervalo de confianza del 95% [IC95%] y se considero significativo un valor de p<0,05.

Resultados

En el análisis univariante, el epítopo compartido (OR=2,68; IC95% 1,11-6,46), el hábito tabáquico (OR=2,79; IC95% 1,12-6,97) y un índice de tabaquismo en paquetes-año alto (>20 paquetes/año) (OR=8,93; IC95% 1,95-40,82) se asociaron con la presencia de anti-PCC positivos. Para el factor reumatoide, la asociación solo fue significativa con el hábito tabáquico (OR=3,89; IC95% 1,06-14,28) y el índice de tabaquismo (OR=8,33; IC95% 1,05-66,22). Mediante análisis de regresión logística ordinal se identificó asociación con títulos elevados de anti-PCC (>200U/mL) en mestizos latinoamericanos, ser homocigoto para el epítopo compartido, tener factor reumatoide positivo y ser gran fumador.

Conclusiones

El ser mestizo latinoamericano, tener epítopo compartido, factor reumatoide y un índice de tabaquismo >20 paquetes/año son factores de riesgo independientes para el desarrollo de artritis reumatoide con anti-PCC positivos a títulos elevados (>200U/mL). En los pacientes portadores del epítopo compartido, la intensidad del consumo de tabaco se asocia más fuertemente que el hábito de fumar con un riesgo incrementado de anti-PCC positivos, observándose una interacción entre ambos factores.

Palabras clave:
Artritis reumatoide
Tabaquismo
Epítopo compartido
Anticuerpos

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