Anti-cyclic citrullinated peptide [anti-CCP] antibodies in juvenile rheumatoid arthritis children

To determine if anti-cyclic citrullinated peptide antibodies [Anti-CCP] can be detected in sera of with juvenile rheumatoid arthritis [JRA] patients and to study its clinical significance. Serum anti-CCP antibodies were measured with ELISA technique in 20 JRA patients. Thirty adult RA patients and 20 apparently healthy children were also included in the study. Correlations between anti-CCP, disease characteristics, medication and radiological damage were also determined in JRA patients. Anti-CCP was positive in 10% [2/20] of JRA patients and in about 67% [20/30] of adult RA patients while it was not detected in healthy children. The two JRA patients were girls with seropositive [IgM-RF] polyarticular subtype. There was a statistically significant difference in radiological damage and rheumatoid factor seropositivity between anti-CCP positive and negative JRA patients. On the other hand, disease duration, antinuclear antibody positivity and medication did not differ statistically between the previous two groups. Anti-CCP antibodies can be detected in the sera of JRA patients but less frequently present than adults with RA. Anti-CCP antibodies are exclusively present in the subset of seropositive polyarticular JRA

Hyaluronate as a biomarker for rheumatiod arthritis activity

Hyaluronic Acid [HA] in synovial tissue may leak into the circulation during synovial inflammation. So serum HA levels are expected to be elevated in rheumatic diseases with synovial involvement such as rheumatoid arthritis. To study the clinical specificity of HA for rheumatoid arthritis [RA] as a possible biomarker related to cartilage and bone turnover and its relation to disease activity. Serum samples from 50 RA were tested. 20 serum samples from healthy blood donors were used as controls. HA serum level in ng/ml was determined using an ELISA-based assay, and correlated with the clinical and laboratory variables. RA patients had mean age 45.9 +/- 7.8 SD years and duration of disease was 2.4 +/- 1.2 years. The study showed significant correlations between the serum HA level and the indices of disease activity, joint swollen scores [R=0.77, p<0.05], morning stiffness [R=0.67, p<0.05], erythrocyte sedimentation rate [ESR] [R = 0.78, p<0.05], C-reactive protein [CRP] [R=0.79, p<0.05] in RA patients. There was significant correlation with disease duration [R=0.68, p<0.05] and Ritchie articular index [RAI] [R=0.82, p<0.05]. No significant correlation of HA level with age of RA patients was observed [R=-0.28, p>0.05]. Serum HA level is a useful marker for the activity and severity of disease in RA patients

Assessment of fatigue in ankylosing spondylitis patients: clinical and self-reported measures

Pain, stiffness, functional impairment, range of motion and quality of life are the main conventional domains used in studies evaluating ankylosing spondylitis [AS]. However, fatigue has been reported as the major complaint of AS patients. To evaluate fatigue as a potential independent domain in comparison to the conventional ones and to evaluate the sensitivity to change after non-steroidal anti-inflammatory drug [NSAID] therapy. Twenty patients were selected as having painful AS [modified New York criteria 1984]. The following variables were recorded at baseline and after six weeks of NSAID therapy: pain [VAS], function [Bath Ankylosing Spondylitis Functional Index], patient's global assessment [VAS], inflammation [night pain], morning stiffness, metrology [Schober test, finger-to-floor] and fatigue using 0-100 VAS scale. Analysis consisted of the prevalence of fatigue [VAS value of at least 50mm] and the sensitivity to change, by calculating the standardized response mean [mean change / S.D. change] [SRM] between before and after NSAID therapy. Fatigue was considered important in 14 patients [out of 20: 70%]. The information provided by pain, function and global assessment explained only 44% of the variability of the variable "fatigue" [similar analyses considering "pain" on the one hand and "function" on the other hand as the dependent variables showed an R value of 34 and 60%, respectively]. The NSAID treatment effect [SRM] was higher for the variables "pain" and "function" [0.76 and 0.71 respectively] than for "fatigue" [0.34]. This study strongly suggests that fatigue should be considered as an independent domain to be systematically evaluated in AS patients and that conventional therapy such as NSAIDs have a lower effect on fatigue than on pain or functional impairment