Added Value of Anti-CD74 Autoantibodies in Axial SpondyloArthritis in a Population With Low HLA-B27 Prevalence
Axial spondyloarthritis (axSpA) is often diagnosed late due to the non-specific nature of its main symptom [chronic back pain (CBP)] and to the paucity of diagnostic markers, particularly in regions with low HLA-B27 prevalence, such as the Middle-East. We tested the performance of IgG4 and IgA anti-...
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doaj-563b7122f4004248b2a174a4a73886832020-11-24T22:16:02ZengFrontiers Media S.A.Frontiers in Immunology1664-32242019-03-011010.3389/fimmu.2019.00574444208Added Value of Anti-CD74 Autoantibodies in Axial SpondyloArthritis in a Population With Low HLA-B27 PrevalenceNelly R. Ziade0Nelly R. Ziade1Iyad Mallak2Georges Merheb3Georges Merheb4Pierre Ghorra5Niklas Baerlecken6Torsten Witte7Xenofon Baraliakos8Xenofon Baraliakos9Department of Rheumatology, Saint-Joseph University, Beirut, LebanonDepartment of Rheumatology, Hotel-Dieu de France Hospital, Beirut, LebanonDepartment of Radiology, Hotel-Dieu de France Hospital, Beirut, LebanonDepartment of Rheumatology, Holy Spirit University, Kaslik, LebanonDepartment of Rheumatology, ND Secours Hospital, Byblos, LebanonBlood Transfusion Center, Hotel-Dieu de France Hospital, Beirut, LebanonPrivate Practice Rheumatology, Cologne, GermanyDepartment of Immunology and Rheumatology, Medical University, Hanover, GermanyRheumazentrum Ruhrgebiet, Herne, Germany0Ruhr-University Bochum, Bochum, GermanyAxial spondyloarthritis (axSpA) is often diagnosed late due to the non-specific nature of its main symptom [chronic back pain (CBP)] and to the paucity of diagnostic markers, particularly in regions with low HLA-B27 prevalence, such as the Middle-East. We tested the performance of IgG4 and IgA anti-CD74 antibodies as an early diagnostic marker for axSpA, compared with the performance of HLA-B27, in Lebanon. Sera of axSpA patients diagnosed by the rheumatologist and also fulfilling the imaging arm of the ASAS criteria (patients) and of blood donors (BD) (controls) were analyzed for HLA-B27, IgG4 and IgA anti-CD74, blinded to clinical characteristics. Receiver Operating Characteristic curves were constructed to identify an optimal cut-off point for anti-CD74 antibodies. Diagnostic properties were calculated (sensitivity, specificity, positive, and positive predictive values (PPV, NPV), Likelihood ratios) for each marker. Forty-nine axSpA patients and 102 BD were included in the final analysis. IgA anti-CD74 correlated poorly with axSpA (Area Under the Curve (AUC) 0.657), whereas IgG4 anti-CD74 had a good discriminative value (AUC 0.837). Respectively, for HLA-B27, IgG4 anti-CD74, and the combination of both, we found a sensitivity of 33-92-33%, specificity of 96-79-98%, PPV 80-68-89%, NPV 75-95-75%, and LR+ 8.2-4.4-16.5. IgG4 anti-CD 74 were positive in 88% of HLA-B27 negative axSpA patients, and correlated with BASDAI. In this first study in a population with low HLA-B27 prevalence, IgG4 anti-CD74 antibodies combined with HLA-B27 showed higher diagnostic value than HLA-B27 alone for early axSpA. IgG4 anti-CD74 should be considered for further evaluation as an early axSpA diagnostic marker in future dedicated research, particularly in patients with CBP.https://www.frontiersin.org/article/10.3389/fimmu.2019.00574/fullspondyloarthritisautoantibodiesautoimmunitydiagnosisHLA-B27anti-CD74 antibodies |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Nelly R. Ziade Nelly R. Ziade Iyad Mallak Georges Merheb Georges Merheb Pierre Ghorra Niklas Baerlecken Torsten Witte Xenofon Baraliakos Xenofon Baraliakos |
spellingShingle |
Nelly R. Ziade Nelly R. Ziade Iyad Mallak Georges Merheb Georges Merheb Pierre Ghorra Niklas Baerlecken Torsten Witte Xenofon Baraliakos Xenofon Baraliakos Added Value of Anti-CD74 Autoantibodies in Axial SpondyloArthritis in a Population With Low HLA-B27 Prevalence Frontiers in Immunology spondyloarthritis autoantibodies autoimmunity diagnosis HLA-B27 anti-CD74 antibodies |
author_facet |
Nelly R. Ziade Nelly R. Ziade Iyad Mallak Georges Merheb Georges Merheb Pierre Ghorra Niklas Baerlecken Torsten Witte Xenofon Baraliakos Xenofon Baraliakos |
author_sort |
Nelly R. Ziade |
title |
Added Value of Anti-CD74 Autoantibodies in Axial SpondyloArthritis in a Population With Low HLA-B27 Prevalence |
title_short |
Added Value of Anti-CD74 Autoantibodies in Axial SpondyloArthritis in a Population With Low HLA-B27 Prevalence |
title_full |
Added Value of Anti-CD74 Autoantibodies in Axial SpondyloArthritis in a Population With Low HLA-B27 Prevalence |
title_fullStr |
Added Value of Anti-CD74 Autoantibodies in Axial SpondyloArthritis in a Population With Low HLA-B27 Prevalence |
title_full_unstemmed |
Added Value of Anti-CD74 Autoantibodies in Axial SpondyloArthritis in a Population With Low HLA-B27 Prevalence |
title_sort |
added value of anti-cd74 autoantibodies in axial spondyloarthritis in a population with low hla-b27 prevalence |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Immunology |
issn |
1664-3224 |
publishDate |
2019-03-01 |
description |
Axial spondyloarthritis (axSpA) is often diagnosed late due to the non-specific nature of its main symptom [chronic back pain (CBP)] and to the paucity of diagnostic markers, particularly in regions with low HLA-B27 prevalence, such as the Middle-East. We tested the performance of IgG4 and IgA anti-CD74 antibodies as an early diagnostic marker for axSpA, compared with the performance of HLA-B27, in Lebanon. Sera of axSpA patients diagnosed by the rheumatologist and also fulfilling the imaging arm of the ASAS criteria (patients) and of blood donors (BD) (controls) were analyzed for HLA-B27, IgG4 and IgA anti-CD74, blinded to clinical characteristics. Receiver Operating Characteristic curves were constructed to identify an optimal cut-off point for anti-CD74 antibodies. Diagnostic properties were calculated (sensitivity, specificity, positive, and positive predictive values (PPV, NPV), Likelihood ratios) for each marker. Forty-nine axSpA patients and 102 BD were included in the final analysis. IgA anti-CD74 correlated poorly with axSpA (Area Under the Curve (AUC) 0.657), whereas IgG4 anti-CD74 had a good discriminative value (AUC 0.837). Respectively, for HLA-B27, IgG4 anti-CD74, and the combination of both, we found a sensitivity of 33-92-33%, specificity of 96-79-98%, PPV 80-68-89%, NPV 75-95-75%, and LR+ 8.2-4.4-16.5. IgG4 anti-CD 74 were positive in 88% of HLA-B27 negative axSpA patients, and correlated with BASDAI. In this first study in a population with low HLA-B27 prevalence, IgG4 anti-CD74 antibodies combined with HLA-B27 showed higher diagnostic value than HLA-B27 alone for early axSpA. IgG4 anti-CD74 should be considered for further evaluation as an early axSpA diagnostic marker in future dedicated research, particularly in patients with CBP. |
topic |
spondyloarthritis autoantibodies autoimmunity diagnosis HLA-B27 anti-CD74 antibodies |
url |
https://www.frontiersin.org/article/10.3389/fimmu.2019.00574/full |
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