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.

联合检测抗CCP抗体、AKA与RF对类风湿性关节炎早期诊断的意义

目的:探讨联合检测抗环瓜氨酸肽抗体(anti-CCP)、抗角蛋白抗体(AKA)与类风湿因子(RF)对类风湿性关节炎(RA)早期诊断的意义。方法:采用酶联免疫吸附法(ELASA)检测anti-CCP,采用间接免疫荧光法检测AKA,采用速率散射比浊法检测RF。结果:RF、anti-CCP、AKA在RA组的阳性率分别为88.75%、86.25%、67.50%,在对照组的阳性率分别为39.22%、15.69%、25.49%,实验组均高于对照组(P<0.01)。三者对诊断RA的灵敏度和特异度分别为anti-CCP:86.25%,88.73%;AKA:67.5%,81.69%;RF:88.75%,71.83%。三者联合检测特异度可达94.37%,阳性预测值可达92.60%。结论:anti-CCP具有较好的灵敏度和特异度;联合检测anti-CCP、AKA与RF可明显提高对类风湿性关节炎早期诊断的特异性。

葡萄糖-6-磷酸异构酶及相关自身抗体诊断类风湿性关节炎的价值

目的探讨葡萄糖-6-磷酸异构酶对类风湿性关节炎的诊断价值,与抗环瓜氨酸肽抗体、类风湿因子之间的相关性以及在临床诊断上的意义。方法对165例RA患者血清和161例非RA患者血清和32例正常人血清用酶联免疫吸附试验、粒子增强免疫透射比浊法进行检测。结果165例RA患者葡萄糖-6-磷酸异构酶敏感度和特异度分别为71.5%和97.9%,与非RA对照组和正常对照组比较差异有显著性(P<0.05);葡萄糖-6-磷酸异构酶与抗CCP抗体和RF重叠阳性率分别为60.6%和57.0%。经统计学分析,葡萄糖-6-磷酸异构酶与抗CCP抗体、RF之间相关性不明显,不完全重叠;三项试验同时检测,以任两项试验阳性为标准诊断RA,则敏感性可提高到77.0%(127/165),特异性97.4%(188/193)。若GPI和抗CCP抗体两项中任一项阳性为标准诊断RA,则敏感性可提高到89.1%,特异性达98.0%。结论葡萄糖-6-磷酸异构酶是协助诊断RA的一个新的实验指标,与抗CCP抗体、RF联合检测能提高RA的早期诊断率。

血清中第二代抗环瓜氨酸肽抗体水平的检测在类风湿关节炎中的诊断价值

目的检测类风湿关节炎患者(RA)血清中的环瓜氨酸肽抗体,探讨其在RA诊断中的价值。方法用ELISA方法分别检测228例RA、192例非RA和71例正常人中抗环瓜氨酸肽(CCP)抗体;用间接免疫荧光法和速率散射比浊法检测抗角蛋白抗体(AKA)和类风湿因子(RF),分析CCP抗体的水平及与AKA、RF的相关性。结果CCP抗体的阳性率在RA中为85.53%,在非RA中为5.21%,正常人全部阴性。3种抗体对RA诊断的敏感性和特异性分别为CCP85.53%、96.20%,AKA59.65%、94.68,RF81.14%、79.47%。CCP抗体与AKA在RA患者血清中的阳性率之间差异非常显著,与RF差异不显著。3种方法的检测结果间存在相关性。结论用ELISA法检测血清中CCP抗体简便、结果可靠,对RA诊断具有高度的敏感性和特异性。

抗突变型瓜氨酸波形蛋白检测在类风湿关节炎诊断中的意义

目的 探讨血清抗突变型瓜氨酸波形蛋白（MCV）抗体水平在诊断类风湿性关节炎（RA）中的意义.方法 用酶联免疫吸附试验（ELISA）测定41例RA患者、39例非RA患者和30例健康体检者血清抗MCV抗体、抗CCP抗体水平,采用Mann-Whitney U检验、Spearman相关分析,并用ROC曲线比较对RA的诊断价值.结果 RA组抗MCV抗体水平（中位数410.00 U/ml）明显高于非RA组（中位数10.60 U/ml）和健康对照组（中位数8.30 U/ml）（U值分别为242.0和318.0,P值均〈0.01）.抗MCV抗体ROC曲线下面积为0.901,标准误0.032,其95%的近似可信区间为0.838～0.963.抗CCP抗体ROC曲线下面积为0.918,标准误为0.027,其95%的近似可信区间为0.865～0.970,两者均有较高的诊断价值.抗MCV抗体敏感度高于抗CCP抗体,但特异度比抗CCP抗体低.抗MCV抗体与抗CCP抗体（r=0.615,P〈0.01）有相关性.结论 抗MCV抗体对RA有较高的诊断价值,可作为一种新的RA血清学指标.

抗环瓜氨酸肽抗体在类风湿关节炎中的应用

类风湿关节炎（RA）是一种致畸性自身免疫性疾病。近年发现抗环瓜氨酸肽抗体是RA新的血清学标志物。A-CCP抗体对RA具有较高的敏感性和特异性,可以用于RA的早期诊断;并且联合其他因子可以提高RA的早期诊断率;A-CCP抗体的出现与骨侵蚀性关节损害有相关性并提示转归不良;在与关节外受累情况的相关性的探讨中有所分歧;A-CCP抗体对未分化关节病的有预测作用,对老年类风湿的早期诊断有较好的敏感性和特异性。

化痰祛瘀蠲痹方治疗类风湿关节炎的随机对照研究

目的:观察中药化痰祛瘀蠲痹方治疗类风湿关节炎(RA)的临床疗效、促进西药减量及稳定病情作用,以初步探讨中药化痰祛瘀蠲痹方治疗RA疗效及的机理。方法:70例RA患者随机分为两组,中药化痰祛瘀蠲痹方加西药治疗组(中药治疗组)35例,西药对照组35例,其中西药对照组口服甲氨喋呤(MTX,每周1次,每次7.5mg),柳氮磺吡啶片(每天3次,每次0.5g),美洛昔康片(莫比可,每天2次,每次7.5mg)。中药治疗组在口服上述西药的同时,加用化痰祛瘀蠲痹方治疗,疗程3个月。观察临床疗效,治疗前后症状、体征及实验室指标变化,西药用量和治疗后3个月病情复发情况。结果:中药治疗组的总有效率优于西药对照组(P<0.05);在改善症状体征(关节疼痛度、肿胀度、压痛度、活动度、握力、晨僵)的积分,与治疗前及对照组治疗后比较差异有显著性(P<0.05或P<0.01);中药治疗组的美洛昔康及MTX的用量(P<0.05或P<0.01)。两组在改善RF、ESR、CRP、PLT、Ig等指标,与治疗前比较差异有显著性(P<0.05或P<0.01),中药治疗组治疗后上述指标改善优于西药对照组(P<0.05或P<0.01)。结论:中药化痰祛瘀蠲痹方加西药治疗RA的疗效优于单独西药治疗,具有促进西药减量作用。温化蠲痹方具有抗炎等免疫调节作用,可能通过抑制RF、Ig等达到治疗RA的作用。

联合检测IgG／IgA型抗环瓜氨酸肽抗体对类风湿关节炎的诊断意义

目的评价IgGBgA型抗环瓜氨酸肽（CCP）抗体对类风湿关节炎（RA）的诊断价值。方法应用INOVA抗CCP3.1 IgG/IgA抗体酶联免疫吸附试验（EtaSA）检测试剂盒定量检测169例RA患者、100例其他风湿性疾病患者、72名健康人血清中的抗CCP3．1抗体水平，与第二代抗CCP-IgG（CCP2）抗体检测试剂盒进行比较，分析其他RA临床及实验室指标与抗CCP3．1抗体之间的相关性。采用两样本均数的t检验、χ2检验及Spearman相关分析进行统计学处理。结果①RA组抗CCP3．1抗体浓度（1122±142）U／ml，显著高于非RA组（13±14）U／ml和健康对照组（6±5）U／ml（P〈0．01）。②抗CCP3．1抗体与抗CCP2抗体的受试者工作特征曲线（ROC）曲线下面积均〉0．9，两者敏感性分别为82％和80％，特异性分别为97％和99％，阳性率为82％和79％，两者间的差异无统计学意义。两者一致性检验κ=0．763，P〈0．01。③抗CCP3．1抗体在抗CCP2抗体阴性患者中的敏感性为20％（7／35）；在类风湿因子（RF）阴性患者中敏感性为43％（18±2）；在抗角蛋白抗体（AKA）阴性患者中敏感性为62％（47/76）；在抗核周因子抗体（APF）阴性患者中敏感性为71％（49±9），在所有其他抗体均阴性的患者中敏感性为13％，提示在其他抗体阴性的患者中检测抗CCP3．1抗体有补充价值。④抗CCP3．1抗体的出现与病情活动度无关，与RF、隐性RF（HRF-IgG）、葡萄糖．6．磷酸异构酶（GPI）抗原、IgG、IgA、AKA和APF呈正相关（P均〈0．05）。结论抗CCP3．1抗体敏感性略高于抗CCP2抗体，对RA诊断具有较高的诊断价值，对于其他实验室指标阴性的RA患者，抗CCP3．1抗体可以提供良好的实验诊断依据。

煤工尘肺患者血清中自身抗体检测

目的探讨煤工尘肺(CWP)患者血清中自身抗体的检出情况。方法采用随机抽样法,以803例CWP壹期患者为研究对象,采用间接免疫荧光法检测其血清中抗核抗体和抗中性粒细胞胞浆抗体(ANCA),采用酶联免疫吸附法检测其血清中髓过氧化物酶(MPO)抗体、抗M2型线粒体抗体(AMA-M2)和抗环瓜氨酸肽(CCP)抗体,采用胶乳增强免疫比浊法检测其血清中类风湿因子(RF),依据年龄、肺功能、接尘年限及接尘性质进行分组分析。结果 803例CWP患者血清中抗核抗体、AMA-M2、RF、抗CCP抗体、ANCA、MPO抗体的阳性率分别为9.7%、7.5%、7.3%、4.0%、2.6%和0.8%;78例抗核抗体阳性标本的核型分布为:颗粒型(43.6%)、胞浆型(20.5%)、均质型(7.7%)和核仁型(5.1%),滴度均为1:100。年龄>70.0组CWP患者抗核抗体阳性率高于年龄~60.0和~70.0岁组(P<0.017);肺功能异常组CWP患者抗核抗体阳性率高于正常组(P<0.01);接尘年限>30.0年组CWP患者抗CCP抗体阳性率高于接尘年限~30.0年组(P<0.017);矽尘组CWP患者抗CCP抗体阳性率低于煤尘组(P<0.01)。结论 CWP患者血清中抗核抗体、AMA-M2、RF和抗CCP抗体阳性率较高;抗核抗体阳性率与年龄和肺功能有关,抗CCP抗体阳性率与接尘年限和接尘性质有关。

金标免疫层析法检测抗环瓜氨酸肽抗体的诊断价值评价

目的:评价金标免疫层析法检测抗环瓜氨酸肽抗体(anti-cyclic citrullinated peptide antibody,抗CCP抗体)的诊断价值,比较与其它三种试剂检测结果的一致性。方法:检测140例类风湿性关节炎(RA)患者和146例对照血清的抗CCP抗体,比较4种不同试剂检测结果间的一致程度。结果:金标免疫层析试剂检测的敏感性为83.6%,特异性为93.2%,与其余3种试剂检测结果一致性极强。结论:金标免疫层析试剂诊断类风湿性关节炎的敏感性和特异性满足临床要求,与其他试剂的检测结果一致性极强,值得临床推广应用。