Abstract
Rheumatoid arthritis (RA) disease activity fluctuates over time. The disease activity score 28 (DAS28ESR) is a widely used and validated scoring system for assessing RA activity; however, it requires time and expertise. This study aimed to develop a new molecular assay capable of rapidly and objectively assessing RA activity. We used a rapid immuno-assay system (FREND™) to measure soluble CD14 (sCD14) levels, which reflect the DAS28ESR. SCD14 concentrations in urine and serum of RA patients were measured, and RA activity and responses to anti-rheumatic drugs were examined at baseline and after 6 months. FREND™ quantified sCD14 levels in a drop of serum and urine accurately and within 5 min. Serum sCD14 concentrations and its changes correlated well with disease activity and treatment responses, and the results were comparable to C-reactive protein. The new composite indices, including the DAS28CD14 and simplified DASCD14, better detected RA activity than a single sCD14 value and correlated strongly with the DAS28ESR. These indices exhibited excellent diagnostic performance for discriminating a good response 6 months after treatment. We developed a new system for assessing RA activity and therapeutic outcome within 5 min. CD14-based composite indices may have utility for accurate and frequent monitoring of RA status.
Highlights
The treat-to-target strategy has improved the prognosis of rheumatoid arthritis (RA) greatly [1]
We found that urinary soluble CD14 (sCD14) levels and the sCD14-to-creatinine ratio in urine tended to correlate with the DAS28ESR, the data did not reach statistical significance (rho = 0.182 (p = 0.070) and 0.188 (p = 0.066), respectively) (Figure A2A)
Our results demonstrate a significant relationship between DAS28ESR and sCD14 levels measured by the FRENDTM-CD14 system, DAS28CD14, and the simplified DASCD14, suggesting the clinical utility of rapid CD14 and CD14-based composite indices for determining RA activity
Summary
The treat-to-target strategy has improved the prognosis of rheumatoid arthritis (RA) greatly [1]. The target is to achieve remission, or low disease activity if remission is not possible, in those with long-standing disease [2]. To this end, the disease activity score 28 (DAS28) was developed and is used widely to assess RA activity [2]. Emerging evidence suggests that CRP may not be a reliable biomarker in patients treated with biologics, anti-IL-6 blocking agents [5]. It is important to identify alternative and reliable biomarkers that can improve assessment of the RA disease activity
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