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.

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.

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.

对比检测血清中抗环瓜氨酸肽抗体水平对类风湿关节炎的诊断价值

目的比较国产和进口诊断试剂盒检测类风湿关节炎(RA)患者血清中的抗环瓜氨酸肽(CCP)的抗体水平的结果,探讨其对RA的临床诊断价值。方法采用国产和进口试剂以酶联免疫吸附试验(ELISA)方法检测120例RA,71例非RA和50例正常人血清中的抗CCP抗体,用免疫速率散射比浊法检测类风湿因子(RF),绘制受试者工作特性(ROC)曲线并计算ROC曲线下面积,分析抗CCP抗体与RF在诊断RA中的相关性。结果国产和进口试剂盒检测抗CCP抗体在RA组中的阳性率为61.7%(74/120)、69.2%(83/120),显著高于非RA组的9.9%(7/71)、7.0%(5/71)和正常组的0.0%(P<0.001),国产和进口试剂盒检测结果之间的差异不显著(P=0.167)。抗CCP抗体和RF对RA诊断的敏感性分别为69.2%、64.2%,特异性为92.9%、67.6%;阳性预测值和阴性预测值为94.3%、77.0%,64.1%、52.7%;似然比为9.82、1.98。抗CCP抗体的ROC曲线下面积为0.829,RF的ROC曲线下面积为0.740,抗CCP抗体对RA的临床诊断效能优于RF指标。抗CCP抗体和RF的检测结果间存在相关性(r=0.29.P=0.001)。结论抗CCP抗体可作为临床诊断RA的一项很好的血清学指标,在RA早期即有很高的特异性,联合检测RF更可提高对RA的早期诊断,但其与RA的发病及预后的关系有待进一步研究。