الفهرس 
Introduction
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Abstract
The study included: Sixty patients with different rheumatic diseases, 40 patients with RA (20 patient with early RA and 20 patient with chronic RA), and 20 patients with other rheumatic diseases(11 patients with systemic lupus erythromatosis,6 patients with Osteoarthritis and 3 patients psoriasis (disease controls), beside 20 healthy subject ) age and sex matched with the patients as healthy controls.
The patients were recruited from the Internal medicine department and Rheumatology Outpatient clinics of Assiut University Hospital. All patients were diagnosed as RA according to 2010 ACR / EULAR (American College Rheumatology / European League Against Rheumatism) rheumatoid arthritis classification criteria (varche et al., 2011).
We exclude from the study patients with Malignancy, chronic infection as TB, Hepatitis B, C and Mixed connective tissue diseases patients. After giving a written informed consent from all participants before starting the study and the study was approved by the Ethical Committee of Faculty of Medicine of Assiut University Hospital.
Detailed history including age, sex , smoking , duration of the disease, morning stiffness ,type of the treatment ,family history and complete clinical examination were done for all patients , stressing on musclo-skeletal examination and local clinical examination of affected joints e.g. number of swollen joints , number of tender joints, assessment of disease activity and functional disability by 28 joint disease activity score calculator (DAS28) according to Van Gestel et al ,1998 .
For all participants the following laboratory investigations were done:
Complete blood count, kidney function test, liver function test , CRP, ESR, Rheumatoid factor, Anti CCP antibodies and Anti-MCV antibodies.
Plain x-ray of the small joints of hand, wrist, feet and the affected joints.
Mean±SD age of those patients with rheumatoid arthritis was 48.97 ± 9.08 years with range between 24 and 65 years while mean age of disease control group was 42.25 ± 6.18 years and range between 20 and 55 years and mean age of healthy control group was 44.05 ± 4.48 years and range between 23 and 65 years. Majority of subjects in the three groups (75% of RA groups, 70% disease control group and health control groups) were females. All groups were matched as regarding age and sex (P> 0.05).
Mean ± SD duration of the disease was 3.45 ± 2.11 years with range between 1 month and 8 years and it was 2.67 ± 1.21 years disease control and range between 4 months and 6 years (P= 0.01). Mean DAS 28 of RA group was 5.09 ± 1.25 ranged from (2.5- 7.45), in disease control group it was 3.62 ± 0.95 with range between (1.8- 5.90), with P value< 0.02.
ESR (first hour) was significantly higher in RA group (55.67 ± 22.12 ml/h) and disease control group (49.09 ± 21.78 ml/h) in comparison to the health control group (13.23 ± 5.71 ml/h). Also, CRP was significantly higher in RA group (22.7 ± 10.78 mg/dl) and disease control group (29 ± 15.17 mg/dl) in comparison to the health control group (13.23 ± 5.71 mg/dl). Both ESR and CRP had no significant differences between RA group and disease control group (P> 0.05).
Mean rheumatoid factor was 23.70 ± 10.91 mg/dl in case of RA group while it was 4 ± 1.32 mg/dl in the disease control group. There was significant increase in mean ±SD level of RF between RA patients and disease control, also with RA patients and healthy control with p value (P value <0.01 and 0.001)
The level of anti-CCP was significantly higher in RA group in comparison to disease group and healthy control, with p value (< 0.001 and 0.01) respectively, there was no significant difference between disease control group and healthy control (P= 0.34).
The level of anti-MCV was significantly higher in RA group in comparison to disease group and healthy control, with significant p value (<0.01 and 0.03 ) respectively, there was no significant difference between disease control group and healthy control (P= 0.31).
Patients with chronic RA (> 1 year) had significantly higher CRP, ESR, Anti-CCP and Anti- MCV in comparison to those with early RA (< 1 year) P value < ( 0.03, 0.01, 0.03 and 0.00 respectively). But there is not significant differences regarding RF (P= 0.98).
Patients with deformity had significantly higher level of RF, Anti-CCP and Anti-MCV in comparison to those patients without deformity.
7 patients with RA in the current study had positive Ant- MCV with negative RF, 4 patients with RA had positive Anti- MCV with negative Anti-CCP while 3 patients with RA had positive Anti- MCV with negative Anti-CCP and negative RF
Anti-CCP had sensitivity 73% and specificity 100% for the diagnosis of RA while Anti-MCV had sensitivity 93% and specificity 90% for diagnosing RA. RF had sensitivity 70% and specificity 55% for diagnosing of RA.
Anti-CCP had sensitivity 37% and specificity 100% for diagnosing of early RA while Anti-MCV had sensitivity 63% and specificity 83% for diagnosing of early. RF had sensitivity 63% and specificity 53% for diagnosing of early RA
Anti-CCP had sensitivity 76% and specificity 100% for diagnosing of chronic RA, while Anti-MCV had sensitivity 67% and specificity 100% for diagnosing of chronic RA. RF had sensitivity 62% and specificity 65% for diagnosing of chronic RA.So Anti MCV is better in diagnosis of RA especially in early stage.
In conclusion, Autoantibodies to citrullinated proteins are specific for RA diagnosis; Antibodies against a modified citrullinated vimentin demonstrate comparable overall diagnostic value in relation to the anti-CCP. Serum anti-MCV antibodies show a significant correlation with the disease activity. Anti-MCV antibodies can be considered a promising diagnostic serological marker in RA patients with high both sensitivity and specificity especially in early cases. The use of Anti-MCV and Anti-CCP collectively give the best result for the diagnosis of rheumatoid disease.