Volume 31, Issue 3, September 2020

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Mediterr J Rheumatol 2020;31(3):362-5
Acute Coronary Syndrome in a Male with Elevated Anti-Cyclic Citrullinated Peptide and no Evidence of Longstanding Rheumatoid Arthritis
Authors Information

Department of Internal Medicine, American University of Beirut, Lebanon

Georges El Hasbani, Lamiaa Hamie, Imad Uthman


A 55-year-old male, previously known to be healthy, presented to the emergency department with a 30-minute history of chest pain radiating to the upper extremities. Vital signs were within normal limits. Four days prior to this presentation, the patient presented for acute onset of polyarthritis and morning stiffness. Significantly elevated titres of anti-cyclic citrullinated peptides (anti‐CCP) were found. In the emergency department, electrocardiography showed ST segment elevations in leads V1 to V5 and aVL. Cardiac enzymes were elevated. The patient underwent cardiac catheterization. A coronary angiography revealed an ectatic proximal left anterior descending (LAD) coronary artery with critical (90-99%) stenosis at the mid segment. A drug-eluting stent was successfully inserted in the LAD without any residual stenosis. Although it is known that anti-CCP positivity is a key element in the pathogenesis of atherosclerosis in RA patients, this case report adds to the existing body of literature which demonstrates that anti-CCP positivity is an independent risk factor for development of cardiovascular events.

Article Submitted: 10 Apr 2020; Revised Form: 12 May 2020; Article Accepted: 1 Jun 2020; Available Online: 30 Sep 2020


This work is licensed under a Creative Commons Attribution 4.0 International License. 

©El Hasbani G, Ghazzal Z, Dakik H, Hamie L, Uthman I.