Diagnostic Utility of Anti-Cyclic Citrullinated Peptide Antibodies Versus Rheumatoid Factor in Libyan Patients with Rheumatoid Arthritis: A Cross-Sectional Study.

AB0293 Factors Influencing Physician Global Assessment of Rheumatoid Arthritis Disease Activity in Usual Clinical Practice

Objective To investigate the serum expressions and clinical significance of Dickkopf-1 in patients with rheumatoid arthritis (RA). Methods The clinical data of 139 patients with RA were retrospectively analyzed, including the disease history, tender joint count (TJC), swollen joint count (SJC), platelet, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-nuclear antibody (ANA), antikeratin antibody (AKA), anti-perinuclear factor (APF), anti cyclic citrullinated peptide antibody (anti-CCP), Dickkopf-1 and radiological (X-ray) staging. The disease activity scale (DAS) was evaluated, and the ESR and CRP levels were included. The relationship between Dickkopf-1 and the clinical data of RA, DAS44 score was analyzed. Results The serum level of Dickkopf-1 in patients with RA was (2.70 ± 0.46) μg/L. There was no relationship between serum Dickkopf-1 level and gender, age, course of disease, CRP, platelet, ANA, AKA, APF, RF, radiological staging in patients with RA (P>0.05). The serum Dickkopf-1 level was significantly associated with TJC, SJC, ESR, DAS44-ESR score, DAS44-CRP score and anti-CCP (r= 0.200, 0.291, 0.178, 0.222, 0.199 and 0.278, P= 0.019, 0.001, 0.037, 0.009, 0.028 and 0.012). Conclusions The serum Dickkopf-1 expression level is closely related to the occurrence and development of RA. Dickkopf-1 may contribute to diagnose the disease activity in patients with RA. Key words: Arthritis, rheumatoid; Dickkopf-1; Disease activity

Rheumatoid arthritis (RA) is a chronic debilitating inflammatory disease affecting mainly the joint, surrounding tissue and other extra-articular structures in the body. RA can lead to destruction of bone and cartilage which may cause severe disability and it is characterized by the presence of serum rheumatoid factor (RF). The anti-cyclic citrullinate peptide (anti-CCP) antibody is another serum biomarker used in RA diagnosis with higher sensitivity and specificity.In this cross-sectional study with retrospective record review, 159 established RA patients from Hospital Universiti Sains Malaysia (HUSM) were recruited. Enzyme-linked immunosorbent assays (ELISAs) for serum RF and anti-CCP were performed. Our goal was to evaluate the significance of anti-CCP antibody in predicting the disease activity and progression in terms of radiological and extra-articular manifestations upon diagnosis.Of the 159 RA patients included in this study, mean age was 48.3 years old and majority (n = 134; 84.3%) were female. A total of 83 (52.2%) and 99 (62.3%) patients had anti-CCP antibody and RF, respectively. Mean Disease Activity Score-28 for Rheumatoid Arthritis with erythrocyte sedimentation rate (ESR) (DAS28-ESR) score for all patients was 4.74 (medium and high disease activity). Fifty-eight (36.5%) patients had radiological defects and 49 (30.8%) patients had extra-articular involvement manifested by rheumatoid nodule, pulmonary involvement, and anemia.In terms of anti-CCP antibody association with clinical and laboratory parameters, a significant co-occurrence of RF and anti-CCP antibody (P = .002) was observed. Anti-CCP antibody was significantly associated with radiological defects in which majority of patients with such defects (n = 40/58; 68.9%) were positive for anti-CCP antibody (P = .001). However, there was no significant difference between mean and classes of disease activity score and extra-articular manifestations between different anti-CCP antibody groups. In addition, extra-articular manifestations were not associated with high disease activity upon RA diagnosisThere was a significant association between anti-CCP antibody positivity and positive RF. Radiological defects were the sole clinical parameter significantly associated with anti-CCP antibody positivity, indicating that patients positive for anti-CCP antibody should be routinely monitored for radiological defects and their onset.

AB0173 Role of Anti Citrullinated Protein Antibodies in Follow-Up and Radiographic Damage in A Group of Patients with Early Rheumatoid Arthritis

Objective To study the association between smoking, anti-modified citrullinated (MCV) antibodies and some associated antibodies, and disease activity. Methods Anti-cyclic citrullinated peptide (CCP) antibodies and anti-MCV antibodies were detected by enzyme-linked immunosorbent assay (ELISA) . RF was detected by latex agglutination test. The clinical and laboratory data of 632 patients with RA were collected. We kept a record of the daily smoking quantity, smoking years of RA patients. T test, analysis of variance (ANOVA) analysis, SNK-q test and Spearman correlation analysis were used for statistical analysis. Results Anti-MCV antibody level was positively related to disease activity score (DAS28), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), tender joint counts (r=0.091, 0.119, 0.122, 0.124, P<0.05). Rheumatoid factor (RF) level was positively related to DAS28, ESR and CRP (r=0.182, 0.192, 0.171, P<0.05). The positive rates of anti-MCV antibodies, anti-CCP antibodies and RF were 1.631 times, 1.489 times and 1.350 times higher in smokers than those of the non-smokers respectively. Their 95%CI were (0.721, 3.690), (0.573, 3.871) and (0.781, 2.334) respectively. The CRP level of smokers [(38±64) mg/L] was higher than that of non-smokers [(30±51) mg//L, t=-2.653, P<0.05]. They were not related to disease activity. The level of antibodies and disease activity were not changed with smoking quantity. The CRP level of patients who smoked 1 to 9 pack-years[(12±25) mg/L] was lower than those who smoked 10 to 19 pack-years and more than 20 pack-years patients [(73±76) mg/L, (39±63) mg/L] (P<0.05). Conclusion Anti-MCV antibody is better than anti-CCP antibody and RF in reflecting disease activity. The CRP level of patients is corrected with smoking. No association is observed between disease activity and the quantity of smoking. Key words: arthritis, rheumatoid; Vimentin; Smoking

To investigate the diagnostic sensitivity and specificity of serum and joint fluid citrulline-containing peptide (CCP), variant antibody (anti-CCP antibody) for active rheumatoid arthritis (RA) and to explore their relationship with other clinical inflammatory indicators, the levels of serum and joint fluid anti-CCP antibodies, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and rheumatoid factors (RF) were detected in 104 active RA patients including 68 with knee joint effusion. The sensitivity of serum anti-CCP antibody to RA was 92.3% (96/104) and that of joint fluid anti-CCP antibody was 82.4% (56/68) (P>0.05). The specificity of serum and joint fluid anti-CCP antibody was 100%. There was no significant correlation between anti-CCP antibody and ESR, CRP, score of DAS28, and RF in RA patients positive for serum anti-CCP antibody (P>0.05). After treatment for half month with integrated traditional Chinese and Western medicine, all indicators were improved. The levels of ESR, CRP, RF, score of DAS28 and serum anti-CCP antibody were decreased significantly after treatment when compared with those before treatment (P<0.05). In our study, two patients with early RA (course<2 months) were negative for serum anti-CCP antibody but positive for joint fluid anti-CCP antibody, and seroconversion was noted with the prolongation of disease duration. Combination of serum anti-CCP antibody and joint fluid anti-CCP antibody is helpful for the “early diagnosis” of RA and evaluation of the severity of RA, thus providing basis for the early treatment. The negativity and positivity of anti-CCP antibody are interchangeable under certain conditions. Key words: Anti-CCP antibody, rheumatoid arthritis, early diagnosis.

Introduction Hashimoto’s thyroiditis and Graves’ disease both constitute autoimmune thyroid diseases (AITD) that frequently coexist with other autoimmune disorders (AID). This study was conducted to evaluate the frequency of rheumatoid arthritis (RA) in patients diagnosed with AITD in relation to the general population. Patients and methods This was a cross-sectional case–control study, conducted on 103 patients with AITD of either Hashimoto’s thyroiditis or Graves’ disease with positive antithyroid peroxidase (TPOAb). A group 100 volunteers, matched for age and sex, with normal thyroid function and negative history of AID, were investigated for the prevalence of RA in the general population (control group). Participants in the study were tested for thyroid profile, rheumatoid factor (RF), erythrocyte sedimentation rate, and C-reactive protein. When appropriate, anticitrullinated peptide antibody was checked. Results Patients with AITD had a higher frequency of RA than the control (P=0.031). Thyroid profile showed no significant difference between patients with and without RA within the group of AITD. In that group, a positive correlation between titers of both RF and TPOAb was observed (r=0.474, P Conclusion RA is more prevalent in patients with AITD than the general population, and the underlying autoimmunity is likely to be the link. Our data highlight the importance of screening thyroid patients for RA especially if present with type 2 diabetes mellitus, another AID, or having a family history of RA.

Background Rheumatoid arthritis (RA) is a widespread autoimmune disease affecting millions of people worldwide. The current markers include anti-cyclic citrullinated peptide (anti-CCP) antibodiesand rheumatoid factor (RF), which are nonspecific and elevated in variousconditions and do not have a prognostic value. They are also elevated in the later stages of the disease. Anti-carbamylated protein (anti-CarP) antibodies have been reported to be associated with joint damage in RA. Therefore, this study aimed to evaluate the sensitivity and specificity of anti-CarP antibodies in individuals with RA and their relationship with inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Methods This was a cross-sectional case-control study conducted from April 2020 to March 2021 at the Saveetha Medical College, Chennai, India. The age makeup of the three groups was evaluated: Group 1 comprised anti-CCP and RF-positive patients; Group 2 comprised anti-CCP and RF-negative patients; and Group 3 was the control group, which comprised healthy volunteers. Patient samples, including blood and serum, have been utilized to conduct various assessments aimed at evaluating biomarkers such as CRP, ESR, RF, and autoantibodies like anti-CCP and anti-CarP. Results This study examined the role of various autoantibodies and biomarkers in RA across three distinct groups. Group 1 predominantly consisted of middle-aged individuals, and women constituted the majority in both Group 1 and Group 2, consistent with higher RA prevalence among females. In Group 1, 65.7% of patients tested positive for anti-CarP, while in Group 2, 48.6% tested positiveeven when RF and anti-CCP antibodies were absent. This suggests a potential diagnostic role for anti-CarP antibodies in identifying RA patients early. CRP and ESR levels were significantly elevated in RA patients (Groups 1 and 2) compared to healthy controls (Group 3), indicating higher inflammatory activity in affected individuals. We also observed that anti-CarPantibodies had a specificity of 69.1% and a sensitivity of 78.2%. Positive correlations between the diagnosis of RA and anti-CarP antibody positivity were observed across the groups and correlated well with the inflammatory markers and signs such as joint damage. The data were found to be statistically significant. Conclusions Our study showed a significant correlation between joint damage and CRP levels and a positive correlation between anti-CarP antibodies and ESR and CRP values. These findings suggest that anti-CarP antibodies can offer certain advantages over RF and anti-CCP antibodies in RA diagnosis due to their early detection potential, higher specificity, complementary diagnostic role, and predictive value for disease severity.

&lt;abstract&gt; &lt;p&gt;Rheumatoid arthritis (RA) is a multifactorial disease which can be triggered by gene-environment interactions. Numerous risk factors have been acknowledged in varied ethnicities, but their generalizability is vague. Hence, proposed to identify impact of etiology on citrullination and how both interact with peptidyl arginine deiminase 4 (PADI4) polymorphism in RA onset among South Indian Tamil RA cases. Studied 207 RA cases and 186 healthy controls for C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), anti-cyclic citrullinated peptide (CCP), anti-Sa (citrullinated vimentin), anti-citrullinated α-enolase peptide-1 (CEP-1) and diseases activity score-28 (DAS-28). Past exposure to studied etiological risk factors obtained through questionnaire. Family history of RA (FHRA), surgery/injury and chikungunya virus (CHIKV) infection significantly contributed to RA (p &amp;lt; 0.05) particularly CHIKV (OR = 6.66, 95% CI 3.92–11.32, p = 0.001). Strikingly, 67.1% of surgery/injury and 80% of CHIKV exposed patients had RA onset within a year. RA cases with tooth decay had impact on RF, anti-CCP, anti-Sa freequeny and anti-CEP-1 level (p &amp;lt; 0.05).Since CHIKV infected cases showed significant anti-Sa (p = 0.04) level and frequency (p = 0.01), they were genotyped for polymorphism in PADI4_92 (rs874881), 104 (rs1748033) and 94 (rs2240340) by Sanger's sequencing which demonstrated that PADI4 confers risk (p &amp;lt; 0.05) for the onset of CHIKV induced RA. This is the initial report that CHIKV may contribute to RA development via vimentin citrullination. FHRA, surgery/injury, CHIKV and smoking posed a key RA risk.&lt;/p&gt; &lt;/abstract&gt;

Rationale: Anti-CCP antibodies are detectable not only in rheumatoid arthritis (RA), but also in psoriatic arthritis (PsA). It is possible those anti-CCP antibodies are associated with features of PsA and that these auto-antibodies are useful in distinguishing PsA from RA. Objective: to evaluate the prevalence and the associations of anti-CCP antibodies in PsA patients; to evaluate the usefulness of anti-CCP antibodies in distinguishing PsA from RA. Methods and Results: The inquiry was designed as a cross-sectional study of 41 PsA patients, 139 RA patients and 147 normal subjects, which recorded demographic data, disease activity and serology: rheumatoid factor (RF), anti-CCP antibodies. Five PsA patients (12.2%) were anti-CCP positive. Compared to anti-CCP negative PsA patients, anti-CCP positive PsA patients had a more frequently a polyarticular disease pattern (p = 0.005), they were more frequently treated with biologics (p = 0.015) and less frequently with classic disease-modifying drugs (p < 0.001). An optimal positive cutoff value for anti-CCP titer was determined (11.6 U/mL), over which it is highly probable that a known PsA patient actually has RA and psoriasis. Discussion: The more aggressive the disease of anti-CCP positive PsA patients indicates the need of a more intensive management regarding anti-rheumatic treatment and follow-up. Anti-CCP antibodies can be a useful tool in differentiating PsA from RA, especially in RA-like forms of PsA, which present no elements pertaining to spondyloarthropathies. Abbreviations: anti-CCP - anti-cyclic citrullinated peptide antibodies; ACR - America College of Rheumatology; CRP - C-reactive protein; CASPAR - The Classification Criteria for Psoriatic Arthritis; DMARD – disease modifying anti-rheumatic drug; EULAR - European League against Rheumatism; ELISA - enzyme-linked immunosorbent assay; ESR - erythrocyte sedimentation rate; HLA – human leukocyte antigen; PsA - psoriatic arthritis; RA - rheumatoid arthritis; RF - rheumatoid factor; ROC - receiver operating characteristic.

Adverse effects of maternal rheumatoid arthritis during pregnancy on children.

Background:Rheumatoid arthritis (RA) is characterized by autoantibody formation and expansion such as the rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA), and antinuclear antibodies (ANA). Autoantibody identification has been considered as...

Objective To discuss the value of high frequency ultrasound for the evaluation of subclinical rheumatoid arthritis. Methods Forty-four rheumatoid arthritis patientswho reached disease activity score (DAS28) clinical remission were included. Ultrasound assess were carried out in all 68 joints, including bilateral temporomandibular joints, sternoclavicular joint, acromioclavicular joint, shoulder joint, elbow joint, wrist joint, 1-5 metacarpophalangeal joints and the interphalangeal joint of the thumb, the 2-5 proximal interphalangeal joints, the 2-5 distal interphalangeal joints, hip, knee joint, ankle joint, tarsus joint, the 1-5 metatarsophalangeal joint, 1-5 toeinterphalangeal joints. Analysis for the correlation between PD, GS score and gender, age, course of disease and clinical disease activity index were conducted. The pain visual analogue scale (VAS), time of morning stiffness, swollen joint count (SJC) and tender joint count (TJC), health assessment questionnaire (HAQ) score, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) and rheumatoid factor (RF), anti cyclic citrullinated peptide (anti CCP) antibody, simplified disease activity index (SDAI), DAS28-CRP, DAS28-ESR were compared. Using Pearson and Spearman to analyze ultrasonic joint synovitis index score and clinical indexes, Student's t-test was employed to assess the significance of difference between two independent sample. Results Twenty-six patients reached/European League against Rheumatism (ACR/EULAR) 2011 remission, 19 patients achieved ACR remission, and 3 patients achieved ultrasound remission. There was correlation between GS score and the course of disease and the number of swollen joints (r= 0.602, 0.470, P<0.01). There was a positive correlation between ultrasound PD score and the patient's pain score, the total score of patients, ACR/EULAR2011, DAS28-ESR, DAS28-CRP (r=0.323, 0.337, 0.329, 0.360, 0.343, P<0.05). The ultrasound PD score also had a positive correlation with CRP, ESR, time of morning stiffness (r=0.474, 0.490, 0.415, P<0.01). Conclusion The subclinical arthrosynovitis can be detected by high frequency ultrasound in most rheumatoid arthritis patients at clinical remission. The PD ultrasound has advantage in evaluating RA activity over GS ultrasound. Key words: Arthritis, rheumatoid; Ultrasonography

Immunologic rheumatic disorders

Objectives The objective of this study was to detect the level of interleukin-33 (IL-33) in patients with rheumatoid arthritis (RA) and to explore the relationship between the level of IL-33 in the serum with the disease activity and functional performance. Background Cytokines are important mediators of immune functions in humans and animals. IL-33, a newly found IL-1 family cytokine, is involved in joint inflammation in RA. Therefore, we aimed to investigate the immunopathological roles of IL-33 in serum RA patients. Patients and methods This study was conducted on a total of 80 individuals: 60 of them were RA patients (55 female and five male) and 20 healthy controls (17 female and three male). All RA patients and controls were evaluated by measuring complete blood count, erythrocyte sedimentation rate, C-reactive protein (CRP), anticitrullinated proteins (anti-CCP), and rheumatoid factor (RF). IL-33 level was measured in the serum of both RA patient group and control group. Results The mean erythrocyte sedimentation rate, serum CRP, anti-CCP antibodies, and RF in addition to the detection percentages of serum IL-33 were significantly higher in the RA group than in the control group. In the RA group, serum IL-33 showed significantly positive correlations with DAS-28, visual analogue scale, RF, CRP, and anti-CCP antibodies. Conclusion IL-33 has an important proinflammatory role in the pathogenesis of RA. Considering their correlation with disease activity, they may become potential therapeutic targets for RA.