ESTER Reumatologia Practice Questions - Título De Especialista Em Reumatologia (Sociedade Brasileira De Reumatologia AMB) Exam

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A 45-year-old woman is evaluated for symmetric inflammatory polyarthritis of the wrists, metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints lasting 10 weeks. Serologic evaluation reveals high titers of anti-cyclic citrullinated peptide (anti-CCP / ACPA) antibodies and IgM rheumatoid factor (RF). Regarding the pathophysiology and clinical significance of ACPA compared to RF, which statement is most accurate?

ACPA recognizes post-translationally modified peptides where lysine is converted to citrulline by peptidylarginine deiminase (PAD) enzymes, exhibiting higher diagnostic specificity (>95%) and prognostic power for erosive disease than RF. ACPA is an IgM autoantibody directed against the Fc portion of IgG, with lower diagnostic specificity than RF in early rheumatoid arthritis. ACPA recognizes post-translationally modified arginine residues converted to citrulline by peptidylarginine deiminase (PAD) enzymes, demonstrating significantly higher specificity (>95%) and predicting radiographic progression. ACPA titers fluctuate directly with daily clinical disease activity, serving as the preferred laboratory marker over CRP to guide immediate monthly DMARD dose adjustments.

Correct Answer:

ACPA recognizes post-translationally modified arginine residues converted to citrulline by peptidylarginine deiminase (PAD) enzymes, demonstrating significantly higher specificity (>95%) and predicting radiographic progression.

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