ABSTRACT
Anti- CCP antibody has recently gained much interest as a marker for early detection and prediction of severe articular and extra-articular disease in rheumatoid arthritis. To evaluate this in patients with active rheumatoid disease and lung involvement, we studied 40 rheumatoid arthritis patients with active disease: 10 patients [6 males and 4 females] have chronic disease with joint effusion but no extra articular affection, 13 chronic patients [5 males and 8 females] with joint effusions and evidence of lung fibrosis, 9 chronic patients [4 males and 5 females] with both joint and pleural effusions but no evidence of lung fibrosis and 8 patients [4 males and 4 females] with relatively recent onset disease with only joint inflammation without effusion plus 8 normal control subjects. Blood anti- CCP was found to be significantly much elevated in all patient groups than controls [p<0.001 for all] and in patients with lung disease than those without [p < 0.001 for both] with highest levels seen in patients with lung fibrosis. In patients without lung disease, levels were slightly [but significantly] higher in those with joint effusion than in those without [p <0.01]. Joint and pleural fluids showed significantly higher anti-CCP levels than blood [p<0.001for both]. Also levels in joint fluid were significantly higher than in pleural fluid [p<0.001]. Blood anti-CCP showed a strong positive correlation with both of ESR and blood rheumatoid factor [r = 0.599, p<0.001 and r = 0.841, p< 0.001 respectively] and with joint and pleural fluid levels [r = 0.786, p<0.001 and r = 0.522, p<0.05 respectively]. A highly significant inverse relation was seen between this antibody in blood and FEV1% [r = 0.593, p <0.001]. We concluded that: anti-CCP antibody could be a good marker for diagnosis of rheumatoid arthritis that can predict patients with severe disease and the association with extra articular affection especially in the lung