Anti-cyclic citrullinated peptide antibody predicts the development of rheumatoid arthritis in patients with undifferentiated arthritis

Background:Clinical outcomes of undifferentiated arthritis(UA)are diverse,and only 40%of patients with UA develop rheumatoid arthritis(RA)after 3 years.Discovering predictive markers at disease onset for further intervention is critical.Therefore,our objective was to analyze the clinical outcomes of UA and ascertain the predictors for RA development.Methods:We performed a prospective,multi-center study from January 2013 to October 2016 among Chinese patients diagnosed with UA in 22 tertiary-care hospitals.Clinical and serological parameters were obtained at recruitment.Follow-up was undertaken in all patients every 12 weeks for 2 years.Predictive factors of disease progression were identified using multivariate Cox proportional hazards regression.Results:A total of 234 patients were recruited in this study,and 17(7.3%)patients failed to follow up during the study.Among the 217 patients who completed the study,83(38.2%)patients went into remission.UA patients who developed RA had a higher rheumatoid factor(RF)-positivity(42.9%vs.16.8%,χ^2=8.228,P=0.008),anti-cyclic citrullinated peptide(CCP)antibodypositivity(66.7%vs.10.7%,χ^2=43.897,P<0.001),and double-positivity rate of RF and anti-CCP antibody(38.1%vs.4.1%,χ^2=32.131,P<0.001)than those who did not.Anti-CCP antibody but not RF was an independent predictor for RA development(hazard ratio 18.017,95%confidence interval:5.803–55.938;P<0.001).Conclusion:As an independent predictor of RA,anti-CCP antibody should be tested at disease onset in all patients with UA.

Diagnostic Value of Antibodies against a Modified Citrullinated Vimentin in Rheumatoid Arthritis

Aim of Work: To investigate the value of the detection of antibodies against modified citrullinated vimentin antibodies (anti-MCV) in comparison with anti-CCP2-for the diagnosis of rheumatoid arthritis (RA). Patients and Methods: The study Included Forty patients with Rheumatoid arthritis (RA). They under went assessment by the disease activity score (DAS-28), visual analogue scale (VAS) and health assessment questionnaire (HAQ). Thirty healthy subjects matched for age and sex served as a control group. Blood samples were obtained from patients and controls for erythrocyte sedimentation rate (ESR), C reactive protein (CRP), rheumatoid factor (RF). Anti-CCP2 and anti-MCV were determined using ELISA technique. Results: Estimated serum levels of anti-CCP2 and anti-MCV were significantly higher in patients compared to controls (p 0.001). There were no significant correlations between anti-MCV levels and age, dis- ease duration, duration of morning stiffness, number of swollen and tender joints, HAQ or ESR in patients with RA, while serum levels correlates significantly with DAS28, VAS and CRP (p 0.05). Anti-CCP2 correlates significantly with DAS28, VAS and CRP and ANA (p 0.05). Serum anti-MCV and anti-CCP2 were significantly correlated with each other (r = 0.483;p The receiver operating characteristic (ROC) curve was drawn and it showed that anti-MCV had diagnostic specificity, sensitivity of 93.3%, 75.5%, respectively, while anti-CCP2 specificity, sensitivity of 98.1%, 85%, respectively. Conclusion: Serum anti-MCV as well as the anti-CCP-2 assay perform comparably well in the diagnosis of RA. In the high-specificity range, however, the anti-CCP2 assay appears to be superior to the anti-MCV test.

The changes and clinical significance of anti CCP antibodies, complement and immunoglobulin in the pathological process of rheumatoid arthritis

Objective:To detect the serum levels of anti-Cyclic Citrullinated Peptide (CCP) antibodies, complement (C3 and C4) and immunoglobulin (IgG, IgA and IgM) in patients with rheumatoid arthritis (RA).Methods: A total of 100 patients with RA were selected as the observation group, and 60 healthy people were selected as the control group. The RA patients were divided into the high disease active group (25 cases), moderate disease active group (30 cases), low disease active group (24 cases) and remission group (21 cases) according to the disease activity score in 28 joints (DAS28 score). The levels of anti-CCP antibodies, C3, C4, IgG, IgA and IgM of each research object were detected. Difference of all the serum indexes between the observation group and control group were compared, as well as that between the RA patients in different disease activity states. Finally, the correlation of anti-CCP antibodies with C3, C4, IgG, IgA and IgM were analyzed.Results: (1) The levels of anti-CCP antibodies, C3, C4, IgG, IgA and IgM in the observation group were obviously higher than that in the control group. (2) Compared with RA in remission, the levels of anti-CCP antibodies, C3, C4, IgG, IgA and IgM of RA in activity were significant higher. Compared with the low disease active group, the levels of anti-CCP antibodies, C3, C4, IgG, IgA and IgM in the moderate and high disease active groups were obviously higher. And the anti-CCP antibodies levels in the high disease active group were significantly higher than that in the moderate ones. The anti-CCP antibodies in RA patients had significant positive correlation with C3, C4, IgG, IgA and IgM.Conclusion:The levels of anti-CCP antibodies, C3, C4, IgG, IgA and IgM in RA patients were increased obviously, and they were correlated with the disease activity of RA. They could be important indexes for the diagnosis and illness monitoring of RA.

Challenges of Rheumatoid Arthritis Management in Sub-Saharan Africa in the 21st Century

In recent decades, several advances have been made in the management of rheumatoid arthritis (RA) both in the diagnostic field and in the therapeutic field. Unfortunately, RA remains poorly studied in black Africa. Epidemiological data are rare and controversial. The estimated prevalence of RA in Africa is about 0% - 2.54%. Risk factors associated with RA must be studied by taking into account special features of black Africa such as the low tobacco consumption in certain regions, the tropical climate and the high frequency of endemic parasitic and viral infections. The initially supposed mildness of RA in black Africa is increasingly challenged. The diagnosis is often made too late because of the scarcity of rheumatologists and ignorance. Diagnostic tools are limited to the clinical data, the erythrocyte sedimentation rate and radiographs as the other tools are poorly available. In addition, there are misconceptions in African communities, responsible for loss of sight during follow-up and treatment discontinuations. This is exacerbated by the shortage of disease-modifying anti-rheumatic drugs (DMARDs) and the inability to afford them. Furthermore, biological agents are very difficult to access. Further studies are essential to better understand the characteristics of RA in black Africa. Thus, collaborations between African and Western research teams seem very important. In order to make available the DMARDs especially biological agents, pharmaceutical companies can contribute through research partnerships. Moreover, governments should provide a better place for chronic inflammatory diseases in the programs against non-communicable diseases. Finally, training must also be promoted to increase the number of specialists and the level of knowledge of other health workers.

贵州汉族类风湿性关节炎白细胞介素18基因的多态性与类风湿因子、抗环瓜氨酸肽抗体的相关性研究

目的探讨贵州汉族人群白细胞介素18(interleukin-18,IL-18)基因启动子单个核苷酸多态性与类风湿性关节炎(rheumatoid arthritis,RA)的发生是否存在关联,以及对类风湿因子、抗环瓜氨酸肽抗体产生的影响。方法采用序列特异性引物的聚合酶链反应技术分析107例RA患者和100例健康体检者的IL-18基因启动子在-607/-137位点的单个核苷酸多态性;分别采用乳胶凝集试验、酶联免疫吸附测定检测RA患者的类风湿因子和抗环瓜氨酸肽抗体。结果 RA患者组与健康对照组在IL-18基因-607位点的等位基因频率的分布及基因型频率的分布比较差异均有统计学意义(χ2=7.651、4.968,P<0.05),两组在-137位点的等位基因频率及基因型频率的分布比较均无统计学意义(χ2=1.439、1.833,P>0.05);在RA患者中,类风湿因子阳性率为69.2%,抗环瓜氨酸肽抗体阳性率为83.2%,IL-18基因-607位点的基因型在抗环瓜氨酸肽抗体阳性组与阴性组间的频率分布差异无统计学意义(χ2=0.709,P>0.05),而在类风湿因子阳性组与阴性组间的基因型频率分布差异有统计学意义(χ2=6.859,P<0.05)。结论贵州地区汉族人群IL-18基因启动子-607位点的多态性与RA的易感性显著相关;IL-18基因启动子-607位点的多态性与RA患者类风湿因子存在关联。