Abstract
Objective: To compare the diagnostic utility of laboratory variables, including matrix metalloproteinase-3 (MMP-3), anti-cyclic citrullinated peptide (CCP) antibodies, rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in patients with erosive and non-erosive rheumatoid arthritis (RA). Methods: We assembled a training set, consisting of 60 patients with RA, all fulfilling the revised criteria of the American College of Rheumatology. A commercial enzyme linked immunosorbent assay (ELISA) was used both to test for anti-CCP antibodies (second generation ELISA kit) and MMP; RF were detected by latex-enhanced immunonephelometric assay. CRP was measured by latex turbidimetric immunoassay. Results: The levels of anti-CCP antibody titers and ESR were significantly higher in patients with erosive disease than those in non-erosive RA patients (p < 0.001 and 0.0341) respectively. Moreover, a higher frequency of elevated titers of anti-CCP antibodies was found in RA patients with erosions compared to patients with non-erosive RA (78.3% vs. 43.2% respectively). The ROC curves of anti-CCP passed closer to the upper left corner than those other markers and area under the curve (AUC) of anti-CCP was significantly larger than AUC of other markers (0.755 for anti-CCP, 0.660 for ESR, 0.611 for CRP, 0.577 for RF, and 0.484 for MMP-3 female). A positive predictive value was higher for anti-CCP antibodies in comparison to other markers. We did not find significant statistical correlation between anti-CCP antibody titers and inflammatory markers such as ESR or CRP. However, we confirmed the correlation of elevated titers of anti-CCP antibodies and RF in both groups of patients whereas the degree of correlation was more significant in non-erosive patients. Conclusion: The results of our study suggest that the presence of elevated anti-CCP antibody titers have better diagnostic performance than MMP-3, RF, CRP and ESR in patients with erosive RA.
Highlights
Rheumatoid arthritis (RA) is a systemic autoimmune disease of unknown etiology, distinguished by chronic inflammation of joints resulting in tissue degradation and joint deformation
The results of our study suggest that the presence of elevated anti-CCP antibody titers have better diagnostic performance than matrix metalloproteinase-3 (MMP-3), rheumatoid factor (RF), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in patients with erosive rheumatoid arthritis (RA)
We examined the levels of anti-CCP, MMP-3, RF, CRP and ESR level in RA patients with erosive and non-erosive disease (Table I)
Summary
Rheumatoid arthritis (RA) is a systemic autoimmune disease of unknown etiology, distinguished by chronic inflammation of joints resulting in tissue degradation and joint deformation. The course of RA is varied ranging from a mild to an aggressive form. Diagnosis and treatment reduce joint destruction, preserve function and improve survival (Subcommittee 2002). The link between chronic inflammation and joint damage has been widely established, especially the relevance of inflammatory markers such as erythrocyte. The damage may progress in spite of decreased inflammatory activity and erosions may develop in patients without clinical sings of significant inflammation (Kirwan 1997, van den Berg 2001). An identification of reliable predictors and markers of joint damage is necessary
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