Adiponectin: A novel prognostic marker for rheumatoid arthritis: A case control study in a tertiary care hospital in central India

Abstract

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disorder characterized by symmetrical synovitis, progressive damage to the articular cartilage and the subchondral bone, pain, fatigue, and disabilityRecognition of RA as early as possible is important, because a significant proportion of the patients develop irreversible joint damage shortly after disease onset & risks associated with its treatment. The adiponectin is an active participant in the regulation of physiological and pathological processes, inflammatory process as mediator. This study was done to compare the progression of rheumatoid arthritis in conjunction with changes in levels of adiponectin and to evaluate its role as a prognostic marker. Analyse serum adiponectin level to evaluate its potential role to assess disease severity in patients of rheumatoid arthritis & compare its level in normal healthy control subjects. This study was conducted in MY Hospital, Indore. We enrolled 50 cases of confirmed rheumatoid arthritis patients of 20-70 years age group and 50 age and sex matched apparently healthy controls. Both cases (n=50) and controls (n=50) were assessed for haematological tests and biochemical tests, lipid profile, uric acid, CRP & adiponectin. The data were expressed as mean ± SD and analysed by using SPSS version 20. P-value of < 0.05 was accepted as statistically significant. The mean age of the cases was 44.74 ± 13.10 and that of controls was 42.26 ± 8.09. Maximum number of study patients were in the age group of 31-40 years & women. The rheumatoid arthritis group was divided into subgroup according to DAS28 Score. Out of 50 cases, 2 patients (4.0%) had remission, 2 patients (4.0%) had low disease activity, 30 patients (60.0%) had moderate disease activity and 16 patients(32.0%) had high disease activity. The mean CRP in the rheumatoid arthritis group was 21.56 ± 25.46 mg/dL while in the control group was 11.09 ± 7.95 mg/L. The difference was found to be statistically significant (p<0.05).The mean ESR in the rheumatoid arthritis group was 21.26 ± 8.88 mm/hour while in the control group was 15.70 ± 5.40 mm/hour. The difference was found to be statistically significant (p<0.05).The mean adiponectin level in the rheumatoid arthritis group was 30.13 ± 13.04 µg/ml while in the control group was 17.08 ± 8.69 µg/ml. The difference was found to be statistically significant (p<0.05).The mean adiponectin level was highest in the high disease activity subgroup and lowest in the low disease activity subgroup.In our study we concluded that patients of rheumatoid arthritis have raised level of adiponectin & CRP as compared to normal healthy control group. Adiponectin might be better marker for RA compare to CRP & ESR. Also higher levels of adiponectin were observed in patients with severe disease. Therefore, adiponectin might be used for screening which will help in predicting disease progression.