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As inflammation in general is associated with citrullination, we sought to investigate <jats:styled-content style=\"fixed-case\">ACPA<\/jats:styled-content> responses in Sudanese <jats:italic>Leishmania<\/jats:italic> patients. Serum samples were collected from Sudanese patients with visceral leishmaniasis (<jats:styled-content style=\"fixed-case\">VL<\/jats:styled-content>) and post\u2010kala\u2010azar dermal leishmaniasis (<jats:styled-content style=\"fixed-case\">PKDL<\/jats:styled-content>) as well as from <jats:styled-content style=\"fixed-case\">ACPA<\/jats:styled-content>\u2010positive Sudanese rheumatoid arthritis patients and compared to healthy Sudanese controls. Levels of circulating C1q\u2010binding <jats:styled-content style=\"fixed-case\">IC<\/jats:styled-content> and anticyclic citrullinated peptide 2(<jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content>2) were investigated using <jats:styled-content style=\"fixed-case\">ELISA<\/jats:styled-content>, and <jats:styled-content style=\"fixed-case\">RF<\/jats:styled-content> was measured with nephelometry. C1q adsorption was carried out to investigate anti\u2010<jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content>2 content in <jats:styled-content style=\"fixed-case\">IC<\/jats:styled-content>. Citrulline specificity was evaluated with control plates with cyclic arginine\u2010containing control peptides. <jats:italic>Leishmania<\/jats:italic>\u2010infected patients had elevated levels of <jats:styled-content style=\"fixed-case\">RF<\/jats:styled-content> and circulating <jats:styled-content style=\"fixed-case\">IC<\/jats:styled-content> but also a significant increase in anti\u2010<jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content>2 (12%) as compared to healthy controls. Anti\u2010<jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content>2\u2010positive <jats:italic>Leishmania<\/jats:italic> patients displayed lower anti\u2010<jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content>2 levels than Sudanese patients with rheumatoid arthritis (<jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content>), and anti\u2010<jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content>2 levels in <jats:italic>Leishmania<\/jats:italic> patients showed a continuum not resembling the dichotomous pattern seen in patients with <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content>. Whereas the anti\u2010<jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content> reactivity of Sudanese <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> sera was strictly citrulline dependent, anti\u2010<jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content>2\u2010positive <jats:italic>Leishmania<\/jats:italic> sera reacted equally well with <jats:styled-content style=\"fixed-case\">ELISA<\/jats:styled-content> plates containing arginine control peptides. There was a strong correlation between anti\u2010<jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content>2 and circulating <jats:styled-content style=\"fixed-case\">IC<\/jats:styled-content> among the <jats:italic>Leishmania<\/jats:italic> patients, but <jats:styled-content style=\"fixed-case\">IC<\/jats:styled-content> depletion only marginally diminished anti\u2010<jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content>2 levels. Our findings stress the importance to interpret a positive <jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content> test carefully when evaluated in non\u2010rheumatic conditions associated with macrophage activation.<\/jats:p>","DOI":"10.1111\/sji.12265","type":"journal-article","created":{"date-parts":[[2015,1,6]],"date-time":"2015-01-06T12:23:30Z","timestamp":1420547010000},"page":"201-208","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Anti\u2010Citrullinated Peptide Antibodies in Sudanese Patients with <i><scp>L<\/scp>eishmania donovani<\/i> Infection Exhibit Reactivity not Dependent on Citrullination"],"prefix":"10.1111","volume":"81","author":[{"given":"E.","family":"\u00c5hlin","sequence":"first","affiliation":[{"name":"Department of Immunology, Genetics and Pathology Uppsala University Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. 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