Anti-Citrullinated Antibodies: What You Need to Know - Internal Medicine

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Anti-citrullinated protein antibodies (ACPA)


Hello, doctor.
Last year, I tested strongly positive for anti-citrullinated protein antibodies (ACPA).
I would like to ask you: Will this antibody turn negative after treatment? How long should I wait before testing again? Thank you.

Miss Pan, 40~49 year old female. Ask Date: 2014/09/18

Dr. Gao Jiankai reply Internal Medicine


Dear Ms.
Pan,
Thank you for your message.
In principle, this antibody is equivalent to your constitution and will not disappear after treatment; it will only fluctuate in levels.
Some treatment methods may reduce the antibody levels, but the activity of the disease is not determined by the presence or absence of antibodies, but rather by the inflammatory condition and clinical symptoms.
Therefore, we will not use aggressive treatments solely to lower antibody levels.
Additionally, since the National Health Insurance currently only covers one test, the physician is unlikely to continue monitoring your antibody levels.

Sincerely,
Department of Allergy, Immunology, and Rheumatology, Changhua Hospital, Ministry of Health and Welfare

Reply Date: 2014/09/18

More Info


Anti-citrullinated protein antibodies (ACPAs), commonly referred to as anti-citrullinated antibodies, are a group of autoantibodies that are primarily associated with rheumatoid arthritis (RA). The presence of these antibodies is significant because they can help in the diagnosis of RA, especially in cases where clinical symptoms are not yet fully developed.
When you mention that you tested positive for anti-citrullinated antibodies, it indicates that your immune system is producing antibodies against citrullinated proteins, which are proteins that have undergone a post-translational modification where the amino acid arginine is converted to citrulline. This process is thought to play a role in the pathogenesis of rheumatoid arthritis, as the immune system mistakenly targets these modified proteins, leading to inflammation and joint damage.

Regarding your question about whether anti-citrullinated antibodies can turn from positive to negative after treatment, the answer is somewhat complex. In many patients with rheumatoid arthritis, the levels of these antibodies may remain positive even after effective treatment and symptom management. This persistence can occur because the production of these antibodies is part of the immune system's response, and once established, they may not disappear entirely, even if the disease is well-controlled. However, some patients may experience a decrease in antibody levels over time, particularly if they achieve remission or significant improvement in their condition.

As for how often you should be tested for these antibodies, it generally depends on your clinical situation and the recommendations of your healthcare provider. If you are undergoing treatment for rheumatoid arthritis, your doctor may suggest monitoring your disease activity through clinical assessments and laboratory tests, including anti-citrullinated antibody levels, at regular intervals. This could be every few months or as needed based on your symptoms and treatment response. It is essential to have an open dialogue with your healthcare provider about your treatment plan and any concerns you may have regarding your antibody levels.

In addition to monitoring anti-citrullinated antibodies, your healthcare provider will likely assess other markers of inflammation and disease activity, such as rheumatoid factor (RF), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). These tests, combined with your clinical symptoms, will provide a comprehensive view of your disease status and guide treatment decisions.

It's also important to maintain a healthy lifestyle, including regular exercise, a balanced diet, and stress management, as these factors can influence your overall health and potentially impact your autoimmune condition. If you experience any new symptoms or changes in your condition, be sure to communicate these to your healthcare provider promptly.

In summary, while anti-citrullinated antibodies may not always turn negative after treatment, monitoring their levels can provide valuable information about your disease status. Regular follow-ups with your healthcare provider will help ensure that your treatment plan remains effective and that you receive the best possible care for your condition.

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