Article rec ¸u le 12 novembre 2019, accept é le 23 décembre 2019Résumé. Les anticorps anti-peptides cycliques citrullinés (anti-CCP) initialement considérés comme très spécifiques pour le diagnostic de la polyarthrite rhumatoïde (PR), permettent de prédire le pronostic de la maladie. Cependant, ces anticorps peuvent être détectés dans d'autres maladies auto-immunes, notamment dans le lupus érythémateux systémique (LES), dont la manifestation la plus courante est l'arthrite inflammatoire, qui est souvent retrouvée dans la polyarthrite rhumatoïde aux stades précoces. L'objectif de notre étude est d'évaluer la prévalence des anticorps anti-CCP et d'analyser les profils de leurs associations avec les auto-anticorps spécifiques du lupus, afin de rechercher un éventuel syndrome de chevauchement au rhupus chez nos patients. Il s'agit d'une étude rétrospective, réalisée à l'unité d'immunologie, au CHU de Blida, Algérie, portant sur 96 patients lupiques, diagnostiqués selon les critères de l'American college of rheumatology (ACR). Les auto-anticorps anti-CCP ont été identifiés par la technique Elisa. L'anti-CCP était positif chez 14,56 % de nos patients, alors que les auto-anticorps anti-ADN, anti-Sm et les facteurs rhumatoïdes (FR) étaient positifs, respectivement chez 47,09 %, 35,41 % et 27,04 % de nos patients. Par ailleurs, la présence des anti-CCP avec les anti-ADN a été retrouvée chez 12,5 % des patients. Parmi les 14 avec anti-CCP+, soit 57, 14 % avaient des arthrites. Nos résultats confirment que les auto-anticorps anti-CCP ne représentent pas un critère pathognomonique de la PR, ce qui rend parfois le diagnostic différentiel avec le lupus difficile, surtout au début de la maladie.
Background: Rhupus is a rare clinical condition where rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) overlap and is characterized by the presence of erosive arthritis with symptoms and signs of SLE. This study aims to investigate the prevalence of anti-CCP antibodies in SLE patients from CHU BLIDA (Immunology unit) and its association with anti-DNA and Anti Sm, in order to make a diagnosis of rhupus among our patients. Methods: Our retrospective study included 96 patients fulfilling the American College of Rheumatology (ACR) classification criteria for lupus. anti-CCP antibodies, anti-Sm were analyzed by ELISA, anti-DNA antibodies were determined by both IFI on Crithidia luciliae substrate and ELISA. The FR by Laser Nephelemetry. Inclusion criteria are the presence of at least one immunological marker of LES with anti-CCP. The sex ratio F / H is equal to 13/1, where the average age is 37 years. Results: Anti-CCP was found in 14 patients (14.6%), 56.25% and 39.59% had positive anti-DNA and antiSm respectively; rheumatoid factors (RF) were positive in 27.08% of cases; anti-CCP / FR combination was found in 7.3% of cases. Besides, the combination of anti-CCP and anti-DNA was found in 12.5%. These two autoantibodies were simultaneously absent in 49.92% of cases. Arthritis was found in 80 patients. Our results concerning the prevalence of immunological and clinical markers of RA such as anti-CCP, RF and arthritis in our lupus patients corroborate with those of the literature. Conclusion: Based on the presence of shared clinical features of RA and SLE along with the presence of anti-DNA and anti-CCP antibodies in our patients, our findings strongly support the contention that rhupus is a true overlap between RA and SLE. Despite being a rare entity, it is important to know the clinical and humoral elements that allow its early diagnosis, making it easier to start treatment in a timely manner and reduce its possible complications.
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