Ankylosis Spondylitis Research Articles

Inflammatory arthritis suspicion in siblings – 17 year old male with ankylosis spondylitis and 15 year old female with juvenile idiopathic arthritis: a case report

Inflammatory arthritis suspicion in siblings – 17 year old male with ankylosis spondylitis and 15 year old female with juvenile idiopathic arthritis: a case report

Effects of Brief Intervention of Behavioural Change on Pain, Mobility, Function, and Quality of Life in Patients with Chronic Ankylosing Spondylitis: A Randomised Clinical Trial

Background: Exercise is essential for maintaining the flexibility and functionality of the joints in patients with ankylosing spondylitis. Additionally, it could ease pain, enhance posture, correct muscular imbalances, facilitate breathing, and generally enhance the quality of life. However, since patient education is poorly structured, patients fail to consider this significant element. Objective: To determine the effects of brief intervention of behavioural change on pain, mobility, function, and quality of life in patients with chronic ankylosing spondylitis Methods: This was a randomized controlled trial with 80 patients in two groups: brief intervention and control. Purpose sampling was used to enrol ankylosing spondylitis patients aged 18 to 60 with stable medical management. Patients with respiratory, cardiac, neurological, pregnancy, or inability to walk unassisted were excluded. All participants provided written informed consent. Cardiorespiratory test duration, physical activity duration per week, flexibility measured by chest expansion, back pain usual, back pain at night, global disease activity, Bath Ankylosing Spondylitis Functional Index (BASFI) and Ankylosing Spondylitis Quality of Life (ASQoL) scale. Week 0 before treatment, 6th week end, and 12th week follow-up were assessed. Data was analysed in SPSS 25.0. Results: The results showed that the demographic variables were equally distributed in both groups without a significant association to any group (p value >0.05) except for urban residence where urban residents were having more percentage of ankylosis spondylitis. The results regarding outcome variables post-interventional 8th week showed that Cardiorespiratory test duration 881±(47.23) and 812±(56.89), Flexibility, chest expansion 6.7±(2.75) and 5.2±(2.14), Back pain usual 2.7±(0.79) and 3.4±(1.04), Back pain at night 3.8±(1.78) and 4.4±(1.54), Global disease activity 6.2±(1.97) and 6.7±(2.03), Bath Ankylosing Spondylitis Functional Index (BASFI) 7.4±(1.16) and 7.2±(1.69) and Ankylosing Spondylitis Quality of Life (ASQoL) scale 12.6±(1.25) and 15.7±(1.05). while the p value (<0.05) showed significant difference in favour experimental group, brief intervention for all variables. Similarly, the follow up results measured at 16th week were significantly different in favour experimental group, brief intervention for all variables, p value (<0.05 Conclusion: The findings of study concluded that brief intervention-based health improving physical activity was significantly on pain, mobility, function, and quality of life in patients with chronic ankylosing spondylitis. Keywords: Brief Intervention, Physical Activity, Ankylosing Spondylitis, Back Pain, Spinal Mobility

Evaluation of the Effectiveness of Artificial Neural Network Based on Correcting Scoliosis and Improving Spinal Health in University Students.

In recent years, spinal disorders, spinal deformities, and scoliosis have become more frequent, especially chronic systemic inflammatory diseases, such as early-onset scoliosis, idiopathic scoliosis, and ankylosis spondylitis, which have unknown causes, insidious onset, and progressive development, resulting in irreversible spinal joint deformities and stiffness at advanced stages and high disability rates. As one of the traditional Chinese health and fitness qigong exercises, Taijiquan has the effect of strengthening the waist and kidneys, sparing the tendons and softening the body, unblocking the meridians, unblocking the qi and blood, and strengthening the body and increasing intelligence. To this end, this paper proposes a data enhancement method that uses the spine line as the control curve to deform the human contours, drawing on the moving least squares deformation method to fit a variety of scoliosis cases and increase the diversity of the dataset, thereby improving the generalisation capability of the network. The colour map and depth map information are then integrated using a four-channel method and a dual feature extraction network structure to improve the accuracy of segmentation.

Incidental posterior rib hyperostosis on chest CT: incidence and etiology.

Incidental rib hyperostosis is defined as asymmetric cortical thickening and sclerosis of the medial posterior ribs and is important because it may lead to unnecessary laboratory testing, additional imaging and occasionally biopsy. The purpose of this study is to identify the incidence of rib hyperostosis within different patient groups known to have an increased propensity towards osteophyte formation and ankylosis. This study was a retrospective cohort study reviewing chest CT examinations in a control group of patients over 50years old and three different patient populations: psoriatic arthritis, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis (DISH). Each CT was evaluated by an attending musculoskeletal and cardiothoracic radiologist to identify rib hyperostosis, osteophyte formation, ankylosis, and spinal curvature. Two senior radiology residents also performed consensus reads and inter-reader reliability was calculated between the two groups. Two hundred eighty-two individuals were included in the study of which 38 (13.5%) had at least one hyperostotic rib. The ankylosing spondylitis population and the DISH population had the highest incidence of rib hyperostosis with a relative risk of 5.6 (p = 0.012) and 5.3 (p = < 0.001) when compared to the control group. There was good inter-reader reliability for the presence of rib hyperostosis with a kappa estimate of 0.739. Incidentally detected rib hyperostosis is most likely the sequela of abnormal stress on the ribs secondary to rib hypomobility from fusion at the costovertebral joint. The incidence of rib hyperostosis is markedly increased in the DISH and ankylosis spondylitis study populations.

Cementless total hip arthroplasty for three different degrees of hip involved secondary to ankylosing spondylitis: an analysis of 195 hips

BackgroundHip involved secondary to ankylosis spondylitis (AS) had a huge influence on hip function. Cementless total hip arthroplasty (THA) can improve hip function. However, no previous study compared the outcomes of THA for AS patients with three different degrees of hip involvement.MethodsThe 195 hips were retrospectively analyzed and divided into non-ankylosed group (group A, 94 hips), fibrous ankylosed group (group B, 49 hips), and bony ankylosed group (group C, 52 hips). postoperative range of motion (ROM), harris hip scores (HHS), the short-form 12 health survey (SF-12), length of stay (LOS), cost, radiological assessments, and complications were compared.ResultsThe follow-up time was (79.4 ± 29.5) months for group A, (80.6 ± 28.9) months for group B, and (79.1 ± 28.9) months for group C (P = 0.966). Group A had the best postoperative hip ROM (P < 0.001), while group A and B can realize better HHS than group C (P < 0.001). The three groups had similar SF-12 postoperatively. For group A, LOS and cost for unilateral procedure were the least than that for group B and C (P = 0.003 and P = 0.001). Similar radiological assessments were achieved for three groups. 1 hip in group A encountered delay union of wound. 1 hip in group C encountered delay union of wound and dislocation and another patient encountered femoral fracture intraoperatively. 12 hips (12.8%) in group A, 6 hips (12.2%) in group B, and 6 hips (11.5%) in group C encountered asymptomatic heterotopic ossification (P = 0.977).ConclusionFor AS patients with hip involvement, THA can improve hip ROM and function. THA for the non-ankylosed hip can realize the better hip function and postoperative ROM than ankylosed hip.

Disease progression associated with low bone mass in axial spondyloarthropathy patients.

We investigated the relationship between bone mineral density (BMD), vitamin D, and computed tomography (CT)-based progression of disease grades of the sacroiliac joint (SIJ), and sought to identify parameters predicting low BMD in patients with axial spondyloarthropathy (axSpA). We collected the ankylosis spondylitis disease activity score (ASDAS), the course of the disease, HLA-B27 status, and vitamin D and C-reactive protein (CRP) levels of 98 axSpA patients. Lumbar spine and femoral BMD were assessed by dual-energy X-ray (DXA), and SIJ grade was determined by CT. The axSpA patients (71 men, 27 women) with a mean age of 31.9 years (range 18-57 years) and body mass index 21.8 kg/m2 (range 15.6-30.6 kg/m2), with disease duration 4.5 years (range 0.3-30 years) were included. A longer disease course, higher CRP level, and lower femoral and lumbar spine BMD were independently related to a higher CT grade. Older age, longer disease course, elevated CRP, and high SIJ CT grade were independently related to lower BMD (femur and/or lumbar spine L1-L4 T scores ≤ -1). Older age, elevated CRP, low vitamin D levels, and high CT grade were independently associated with low femur and lumbar spine BMD. However, a longer disease course was independently related to low femur BMD, but not low lumbar spine BMD. Thus, inflammation and low femoral and lumbar spine BMD were strongly correlated with a high SIJ CT grade, and inflammation, low vitamin D levels, and a longer disease course within a certain time range influenced bone loss in axSpA.

Synchronous or sequential cementless bilateral total hip arthroplasty for osseous ankylosed hips with ankylosing spondylitis

BackgroundBilateral osseous ankylosed hips secondary to ankylosis spondylitis (AS) are relatively rare but impact the quality of life hugely. Cementless total hip arthroplasty (THA) for bilateral osseous ankylosed hips with AS is a challenging procedure. No previous literature compares the clinical outcomes of synchronous and sequential bilateral THA for these special patients.Methods23 patients (46 hips) were retrospectively analyzed and divided into bilateral THA synchronously (group A) and sequentially (group B). The clinical measurement, radiological assessments, and complications were compared. Independent sample T test was used for data analysis.ResultsHarris Hip Scores (HHS) improved greatly for both groups (P = 0.58) as well as the range of motion (P = 0.64). But group B can realize shorter time (3.6 ± 1.2 days) to walk for the first time postoperatively (P = 0.02). Group A needed more blood transfusions (P = 0.028). For group A, no statistical difference was found in the bilateral inclination of cup (IC) (P = 0.48) and femoral offset (FO) (P = 0.07). For group B, no statistical difference was observed in bilateral IC (P = 0.37) but in bilateral FO (P = 0.04). Group A showed the fewer difference of bilateral IC (P = 0.02), while comparative measurements were found for two groups in the difference of bilateral FO (P = 0.78) and leg length discrepancy (P = 0.83). For both groups, the total hospital expense for each patient was similar and almost all patients were very satisfied with the outcomes. For group A, one patient encountered femoral fracture intraoperatively and another patient encountered hip dislocation and delay union of wound. 3 hips from group A and 3 hips from group B encountered heterotopic ossification.ConclusionsOur retrospective research demonstrated that cementless bilateral THA was a reliable treatment for osseous ankylosed hip due to AS. Synchronous and sequential bilateral THA can realize similarly satisfactory clinical outcomes and radiographic evaluation.

LncRNA MEG3 Suppresses the Progression of Ankylosis Spondylitis by Regulating the Let-7i/SOST Axis.

Ankylosis spondylitis (AS) is a disease mainly characterized by sacroiliac joint and spinal attachment point inflammation. Long non-coding RNA (lncRNA) plays a key role in the progression of many diseases. However, few studies have been conducted on the function of lncRNA maternally expressed gene 3 (MEG3) in AS. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to measure the relative levels of MEG3, microRNA let-7i, sclerostin (SOST), and inflammatory cytokines. Dual-luciferase reporter assay, RNA immunoprecipitation (RIP) assay and biotin-labeled RNA pull-down assay were used to confirm the interaction between MEG3 and let-7i or let-7i and SOST. In addition, western blot (WB) analysis was performed to detect the protein levels of osteogenesis markers and SOST. The expression levels of MEG3 and SOST were decreased and let-7i was increased in AS patients. MEG3 could interact with let-7i in AS fibroblasts, and let-7i overexpression reversed the suppressive effect of MEG3 upregulation on the inflammation and bone formation of AS. Additionally, let-7i could target SOST, and SOST silencing reversed the inhibitory effect of let-7i inhibitor or MEG3 overexpression on the inflammation and bone formation of AS. Furthermore, SOST expression was positively regulated by MEG3, while was negatively regulated by let-7i. Our results revealed that lncRNA MEG3 promoted SOST expression to restrain the progression of AS by sponging let-7i, which provided a treatment target for AS.

Evaluating upadacitinib for the treatment of rheumatoid arthritis

ABSTRACT Introduction The introduction of JAKs inhibitors for the treatment of rheumatoid arthritis represents a promising new era in the management of the disease. New compounds under investigation, like upadacitinib, with greater selectivity for JAK1 inhibition have recently been approved for the treatment of adults with moderately to severely active rheumatoid arthritis who have had an inadequate response or intolerance to conventional synthetic disease-modifying antirheumatic drugs. Areas covered Herein, the authors review the pharmacological data, the therapeutic efficacy, and safety data of upadacitinib before providing the reader with their critical evaluation and future perspectives. Expert opinion Upadacitinib was able to accomplish all the primary and secondary end points in most of the trials, with a safety profile that is similar to the other JAK inhibitors. It has also demonstrated superiority over a tumor necrosis factor inhibitor and data on new indications is also favorable. Upadacitinib is a promising new drug for the treatment of rheumatoid arthritis. Glossary Adalimumab: ADA; American College of Rheumatology: ACR; Assessment of Spondylarthritis International Society 40: ASAS40; Ankylosis Spondylitis: AS; Area under the Curve: AUC; Biological Disease-modifying arthritis drugs: bDMARDs; Clinical disease activity index: CDAI; C Reactive Protein: CRP; Conventional Synthetic Disease-modifying arthritis drugs: csDMARDs; Deep Venous Thrombosis: DVT; Disease arthritis score: DAS.

P035 Important role of HLA laboratory in the diagnosis of HLA associated diseases

A 43 years old female patient was introduced to our polyclinic and the treating physician referred her to our HLA-lab for HLA-B27 typing. According to the ordering physician the patient is suffering from back pain, stiffness in the morning, degenerative changes, facet Arthropathy and her hip was also affected, hence we were suspicious that the patient was suffering from ankylosing spondylitis. The blood pressure was normal, BMI 29, WBC 6,849/L, HB 146 g/dl, Glc 5.5 mmol/L, PTH 56.6 ng/L, anti gliedin 3.88 mg/L, CRP 3.46 mg/L. According to published studies HLA-B27 is present in 85% of patients with ankylosing spondylitis. This means that HLA-B27 positive individuals are approximately 85 times at more risk to develop ankylosing spondylitis compared to the general population. However, in this case our HLA-typing, which was performed for HLA-Class I by using SSO for low/intermediate resolution, showed a negative result for HLA-B27. The negative HLA-typing results for HLA-B27 in this female patient do not totally exclude the presence of ankylosing spondylitis because 15% of affected patients do not carry this HLA allele. However, the absence of HLA-B27 in this patient makes the diagnosis of ankylosing spondylitis unlikely. This interpretation is supported by the fact, that Ankylosing spondylitis predominantly affects male patients and not females in the age > 30 years old. In addition, the described clinical symptoms could be caused by many other various diseases. At our lab we usually performed the testing of all HLA class I alleles even when only single allele requested. In this case we have observed that the patient has beside HLA-B27 HLA-B51 also, which is very strongly associated with Behcet’s disease. Behcet’s disease has similar clinical symptoms to ankylosis spondylitis. Our positive results for HLA-B51 directed the treating physicians to perform further investigations to confirm Behcet’s disease instead of ankylosing spondylitis. The presented case highlights the important role of HLA laboratory in the diagnosis of HLA associated diseases.

Clinical curative effect of tranexamic acid on perioperative blood loss in primary total hip arthroplasty among patients with ankylosis spondylitis

Objective To explore the validity and safety of application of tranexamic acid(TAX) on amount of blood loss during operative period in patients with ankylosing spondylitis who were underwent primary unilateral total hip arthroplasty. Methods The prospective study was conducted. The clinical data of 50 cases of ankylosing spondylitis who underwent unilateral primary total hip replacement at the Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University from May 2015 to August 2017 were selected. A total of 50 patients were enrolled and randomized into the study group (n=25) and control group (n=25) random number table . The patients in the study group were given 15 mg/kg TXA dissolved in 250 ml normal saline by intravenous administration at 10 minutes before incision, and intra-articular injection after close the joint capsule. The patients in the control group were given with 250 ml 0.9% saline by intravenous and 10 ml 0.9% saline by hip joint capsule injection at the the same dose instead. The amount of overt blood loss, hidden blood loss, haemoglobim level, hematocrit, the volume of blood transfusion, and number of blood transfusion were compared between two groups. The Color Doppler flow imaging of the lower limbs was performed to detect deep venous thrombosis and pulmonary embolism. Measurement data were expressed as mean±standard deviation (±s). It was expressed by t test. Count data were expressed as percentage (%). The data were statistically analysized by χ2 test between two groups. Results The amount of overt blood loss, hidden blood loss, haemoglobin level, hematocrit, blood transfusion volume and blood transfusion in the study group were (538.9±103.6) ml, (93.2±30.6) ml, (103.4±10.2) g/L, (0.31±0.04)/L, (210.4±45.7) ml, 4 cases. The indexes in the control group were (831.5±120.8) ml, (175.8±42.3) ml, (95.7±10.1) g/L, (0.26±0.03)/L, (439.8±78.1) ml, and 12 cases, respectively. In patients of study group, the amount of intraoperative blood loss, volume of postoperative drainage, amount of visible blood loss, hidden blood loss and the volume of blood transfusion were less than those of patients in control group, and the difference was statistically significant (P<0.05). Calf muscular venous thrombosis was found in one case of observation group. No pulmonary embolism occurred in both groups. Conclusion The application of TAX can significantly decrease the amount of blood loss during operative period in patients with ankylosing spondylitis who were underwent primary unilateral total hip arthroplasty without increasing risk for deep venous thrombosis. Key words: Tranexamic acid; Arthroplasty, replacement, hip; Spondylitis, ankylosing; Postoperative hemorrhage; Venous thrombosis

Genome-wide DNA methylation profile analysis identifies differentially methylated loci associated with ankylosis spondylitis

BackgroundAnkylosing spondylitis (AS) is a chronic rheumatic and autoimmune disease. Little is known about the potential role of DNA methylation in the pathogenesis of AS. This study was undertaken to explore the potential role of DNA methylation in the genetic mechanism of AS.MethodsIn this study, we compared the genome-wide DNA methylation profiles of peripheral blood mononuclear cells (PBMCs) between five AS patients and five healthy subjects, using the Illumina Infinium HumanMethylation450 BeadChip. Quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR) was performed to validate the relevance of the identified differentially methylated genes for AS, using another independent sample of five AS patients and five healthy subjects.ResultsCompared with healthy controls, we detected 1915 differentially methylated CpG sites mapped to 1214 genes. The HLA-DQB1 gene achieved the most significant signal (cg14323910, adjusted P = 1.84 × 10–6, β difference = 0.5634) for AS. Additionally, the CpG site cg04777551 of HLA-DQB1 presented a suggestive association with AS (adjusted P = 1.46 × 10–3, β difference = 0.3594). qRT-PCR observed that the mRNA expression level of HLA-DQB1 in AS PBMCs was significantly lower than that in healthy control PBMCs (ratio = 0.48 ± 0.10, P < 0.001). Gene Ontology (GO) and KEGG pathway enrichment analysis of differentially methylated genes identified four GO terms and 10 pathways for AS, functionally related to antigen dynamics and function.ConclusionsOur results demonstrated the altered DNA methylation profile of AS and implicated HLA-DQB1 in the development of AS.

Calprotectin in rheumatic diseases: a review.

Calprotectin also known as MRP8/14 or S100A8/A9 is a heterodimeric complex of two S100 calcium-binding proteins: myeloid-related protein 8 (MRP-8 or S100A8) and MRP-14 (or S100A9). At present, according to many authors, it is considered that calprotectin MRP8/14 is a potentially more sensitive biomarker of disease activity in rheumatoid disease than conventional inflammatory indices such as the erythrocyte sedimentation rate, C-reactive protein and others. A review of the literature on concentration of calprotectin in patients with some rheumatic diseases (rheumatoid arthritis, juvenile idiopathic arthritis, adult-onset Still’s disease, systemic vasculitis, polymyalgia rheumatica, ankylosis spondylitis, systemic lupus erythematosus, and primary Sjögren’s syndrome) is presented.

Effects of Pilates, McKenzie and Heckscher training on disease activity, spinal motility and pulmonary function in patients with ankylosing spondylitis: a randomized controlled trial

The optimal management of ankylosis spondylitis (AS) involves a combination of nonpharmacologic and pharmacologic treatment aiming to maximize health-related quality of life. The primary objective of our study was to demonstrate the benefits of an original multimodal exercise program combining Pilates, McKenzie and Heckscher techniques on pulmonary function in patients with AS, while secondary objectives were to demonstrate the benefits of the same program on function and disease activity. This is a randomized controlled study on ninety-six consecutive patients with AS (axial disease subset), assigned on a 1:1 rationale into two groups based on their participation in the Pilates, McKenzie and Heckscher (group I) or in the classical kinetic program (group II). The exercise program consisted of 50-min sessions performed 3 times weekly for 48 weeks. Standard assessments were done at week 0 and 48 and included pain, modified Schober test (mST) and finger-floor distance (FFD), chest expansion (CE) and vital capacity (VC), as well as disease activity Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional Bath Ankylosing Spondylitis Functional Index (BASFI) and metrology index Bath Ankylosing Spondylitis Metrology Index (BASMI). Groups were comparable at baseline; we demonstrated significant improvement between baseline and after 48 weeks of regular kinetic training for all AS-related parameters in both groups. However, significant improvement was found in pain, lumbar spine motility (mST, FFD), BASFI, BASDAI and BASMI in AS performing the specific multimodal exercise program at the end of study (p = 0.001). Although there were significant improvements in CE in both groups as compared to baseline (group I, p = 0.001; group II, p = 0.002), this parameter increased significantly only in group I (p = 0.001). VC measurements were not significantly changed at the end of the study (group I, p = 0.127; group II, p = 0.997), but we found significant differences within groups (p = 0.011). A multimodal training combining Pilates, McKenzie and Heckscher exercises performed regularly should be included in the routine management of patients with AS for better control of function, disease activity and pulmonary function.

THU0411 Utility of ultrasound scores in assessment enthesitis on anti-TNF therapy of spondyloarthritis patients

BackgroundEntheses affectation is the hallmark lesions in ankylosis spondylitis (AS). In front of the cardinal role of enthesis inflammation on SpA is the finding that clinical examination lacks sensitivity and...

SP0048 Spondylarthropathy- a fibroblast driven disease?

Fibroblasts, in particular the synovial cells, play a key role in the pathogenesis of rheumatoid arthritis. Recent evidence not only supports the concept that they are involved in the destruction...

Management of AS—new guidelines in the spotlight

New guidelines for the management of ankylosis spondylitis provide evidence-based disease management recommendations, which aim to be the ideal standard practice. How robust are these suggestions and are they applicable to the worldwide community of rheumatologists practicing in very different clinics around the globe?

A case of ankylosis spondylitis accompanied by severe morphological changes of the temporomandibular joint

A case of ankylosis spondylitis accompanied by severe morphological changes of the temporomandibular joint

Clinical significance of specific spinal mobilization for patients with ankylosing spondylitis evaluated by quantitative assessments and patient interviews

Purpose. To assess individual responses to specific spinal mobilization (SSM) in terms of spinal mobility, perceived stiffness, pain and activities of daily living (ADL) in patients with Ankylosis Spondylitis (AS), and whether and how interviews supported or supplemented the quantitative results.Methods. Spinal mobility was recorded by the fingertip-to-floor distance, the Modified Schober Test, myerinometer, and the chest expansion test. The measures corresponding to sites targeted by SSM was used as effect variables, and the other as control variables. Visual analogue scales assessed pain and stiffness. The Bath Ankylosing Spondylitis Functional Index assessed ADL. A single subject experimental design was applied. The patients' experiences were investigated by semi-structured qualitative interviews.Results. Six patients completed 12 sessions of SSM. In five patients spinal mobility improved by 6-38%, and perceived stiffness reduced by 6 – 82%. Further improvements were found after three months. Improvements were not seen in the control variables. The interviews revealed that to become less stiff had various meanings for the patients, the SSM helped to get control of motion, and the conversations with the therapists enabled them to cope with the situation.Conclusions. The findings suggest that SSM can diminish spinal stiffness, but this had different meanings for the patients. What were important were what they experienced and learnt during the therapy process.

Antibodies to mutated citrullinated vimentin for diagnosing rheumatoid arthritis in anti-CCP-negative patients and for monitoring infliximab therapy

IntroductionAntibodies against cyclic citrullinated peptides (CCPs) are useful for diagnosing rheumatoid arthritis (RA). Antibodies to mutated citrullinated vimentin (MCV) were described recently in RA. The aims of this study were to evaluate the usefulness of anti-MCV for diagnosing RA in anti-CCP-negative patients and to monitor anti-MCV titres during infliximab therapy for RA.MethodsWe studied two groups of RA patients, one with (n = 80) and one without (n = 76) anti-CCP antibodies. The specificity of anti-MCV was evaluated by investigating 50 healthy controls and 158 patients with other rheumatic diseases (51 psoriatic rheumatism, 58 primary Sjögren syndrome, and 49 ankylosis spondylitis). Serum anti-MCV and anti-CCP titres were measured in 23 patients after 6, 12, 18, and 24 months of infliximab treatment. Anti-CCP2 and anti-MCV levels were assayed using a commercial enzyme-linked immunosorbent assay. IgM rheumatoid factor was determined by nephelometry.ResultsIn accordance with the cutoff values recommended by the manufacturer, the specificity of anti-MCV antibodies was 90.9%. We adjusted the cutoff values to obtain the same specificity as that of anti-CCP antibodies (94.2%). With this optimal cutoff, anti-MCV antibodies were found in 11.8% (9/76) of RA patients without anti-CCP, and similarly, anti-CCP antibodies were found in 11.2% (9/80) of RA patients without anti-MCV. Anti-MCV antibodies were positive in 6 patients who tested negative for both anti-CCP and rheumatoid factor. Anti-MCV titres were significantly decreased after 18 and 24 months of infliximab therapy compared with baseline (P < 0.01) as a significant decrease of anti-CCP levels occurred only at 24 months (P < 0.04). Moreover, an anti-MCV decrease was significantly associated with DAS28 (disease activity score using 28 joint counts) improvements 12 months into therapy.ConclusionsOur results suggest that anti-MCV antibodies may be valuable for diagnosing RA in anti-CCP-negative patients without replacing them as an equivalent number of anti-CCP-positive RA patients test negative for anti-MCV. Moreover, anti-MCV antibodies could be useful for monitoring the effects of infliximab therapy.