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Are anti-cyclic citrullinated peptide antibodies pathogenic in rheumatoid arthritis?

Nature Clinical Practice Rheumatology volume 2, pages 400–401 (2006)Cite this article

Much of the current thought regarding the etiology of rheumatoid arthritis (RA) is focused on the HLA genes that contain the 'shared epitope', and on the central pathogenic role of cytokines, especially tumor necrosis factor.1 Given the substantial improvement in clinical signs and symptoms of disease in patients following treatment with tumor necrosis factor antagonists, this is a very well-supported view. Nevertheless, recent studies have provided new insights into the etiology of RA, and strongly suggest that humoral autoimmunity might have a substantive, possibly even causal, role in the pathogenesis of RA. Animal studies by this author's group have provided additional information about the pathogenic capabilities of newly characterized, RA-related autoantibodies.

It has been observed that B-cell-depletion therapy with an anti-CD20 monoclonal antibody can be remarkably beneficial in patients with RA, even patients in the later stages of disease.2 This was a remarkable finding, although it is not certain whether the treatment effect is caused by the depletion of autoantibodies and immune complexes or by the loss of other immunoregulatory functions of B cells. The inescapable conclusion is that B cells are not innocent bystanders in the disease process.

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  1. the Head of the Division of Rheumatology at the University of Colorado Health Sciences Center in Denver, CO, USA

    V Michael Holers

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  1. V Michael Holers
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Correspondence to V Michael Holers.

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The author declares no competing financial interests.

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Holers, V. Are anti-cyclic citrullinated peptide antibodies pathogenic in rheumatoid arthritis?. Nat Rev Rheumatol 2, 400–401 (2006). https://doi.org/10.1038/ncprheum0247

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