Anti-carbamylated protein autoantibodies associated with mortality in Spanish rheumatoid arthritis patients

PLoS One. 2017 Jul 3;12(7):e0180144. doi: 10.1371/journal.pone.0180144. eCollection 2017.

Abstract

Patients with rheumatoid arthritis (RA) have an increased mortality rate that is associated with the presence of RA-specific autoantibodies in many studies. However, the relative role of rheumatoid factor (RF), anti-CCP antibodies and the most recently established RA-autoantibodies, directed against carbamylated proteins (anti-CarP antibodies), is unclear. Here, we have assessed the role of these three antibodies in 331 patients with established RA recruited from 2001 to 2009 and followed until November 2015. During this time, 124 patients died (37.5%). This death rate corresponds to a mortality rate 1.53 (95% CI 1.26 to 1.80) folds the observed in the reference population. We used for analysis of all-cause mortality the Cox proportional hazard regression model with adjustment for age, sex and smoking. It showed a trend for association with increased mortality of each of the three RA autoantibodies in antibody-specific analysis (hazards ratio (HR) from 1.37 to 1.79), but only the HR of the anti-CarP antibodies was significant (HR = 1.79, 95% CI 1.23 to 2.61, p = 0.002). In addition, the multivariate analysis that included all autoantibodies showed a marked decrease in the HR of RF and of anti-CCP antibodies, whereas the HR of anti-CarP remained significant. This increase was specific of respiratory system causes of death (HR = 3.19, 95% CI 1.52 to 6.69, p = 0.002). Therefore, our results suggest a specific relation of anti-CarP antibodies with the increased mortality in RA, and drive attention to their possible connection with respiratory diseases.

MeSH terms

  • Adult
  • Aged
  • Arthritis, Rheumatoid / immunology*
  • Arthritis, Rheumatoid / mortality
  • Autoantibodies / immunology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Spain

Substances

  • Autoantibodies

Grants and funding

Funding was provided by the Instituto de Salud Carlos III (Spain) through grants PI14/01651 to AG, and PI12/01909 and RD12/0009/0008 to JJG-R. These grants are partially financed by the European Regional Development Fund of the EU (FEDER). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.