Anti-cyclic citrullinated peptide antibodies in rheumatoid arthritis: relation to disease activity and joint destruction

To assess the diagnostic value of anti-cycle citrullinated peptide [anti-CCP] antibodies in patients with rheumatoid arthritis [RA] and its relation to disease activity and severity of erosions and to determine whether the combined measurements of rheumatoid factor[RF] and [anti-CCP] antibodies add to diagnosis of RA. In this cross sectional study, serum samples from 60 patients with RA, 40 patients with other rheumatic diseases and 30 healthy subjects were tested for anti-CCP antibodies by enzyme linked immunosorbent assay [ELISA] and IgM rheumatoid factor [IgM RF] with Latex Fixation Test [LFT] and then titrated with Rose Waaler test [RW]. Radiographs of hands and wrists were taken then the joint destructions were quantified using Larsen's score. Sensitivity was higher for IgM RF [76.6%] but the specificity was higher for [anti-CCP] antibodies [95% and 96.6% versus other rheumatic disease patients and control subjects, respectively]. The combination of both IgM RF and anti-CCP measurements improve both sensitivity and specificity. Positivity of anti-CCP and RF were associated significantly with constitutional symptoms and extra-articular manifestations. Significant differences were found between RA positive and negative cases of anti-CCP or RF as regards degree of disease activity and radiological changes. While no significant differences were found when positive and negative cases of anti-CCP or RF were compared as regards duration of disease and duration of morning stiffness. RF test has a high sensitivity and weak specificity but anti-CCP has a moderate sensitivity and excellent specificity. So combined RF and anti-CCP tests are useful in establishing the diagnosis of RA especially in RA patients with negative RF

Carotid atherosclerosis risk factors in systemic lupus erythematosus

To investigate lipid metabolism, inflammation and lupus-related factors as risk factors for occurrence of carotid atherosclerosis in premenopausal women with systemic lupus erythematosus [SLE]. Thirty premenopausal women with systemic lupus erythematosus [SLE] were included in this study. Their age ranged from 18 to 45 years. All of them were subjected to full history taking, thorough clinical examination, laboratory investigations, disease activity assessment using SLE disease activity index [SLEDAI] and assessment of SLE-related disease damage according to the systemic lupus international collaborating clinics [SLICC] damage index. Duplex ultrasonography was used to measure the intima-media thickness [IMT] and carotid plaques. Eleven out of the 30 SLE patients [36.6%] had carotid arteriosclerosis. Among those patients, the risk factors those associated with occurrence of carotid arteriosclerosis included dyslipoproteinemia where OR and 95% CI for higher levels of total cholesterol, low density lipoproteins [LDL] and lipoprotein-alpha LP[alpha] were 1.019 [1.003-1.036], 1.19 [1.08-1.31] and 1.023[1.005-1.033], respectively, higher levels of inflammatory markers where OR and 95% CI for C-reactive protein and fibrinogen were 1.70[1.07-1.90] and 1.40[1.01-1.60], respectively and some of lupus-related factors where OR and 95%CI for duration of disease, SLICC damage score, cumulative dose of prednisone and duration of prednisone use were 1.65 [1.07-2.25], 1.80 [1.29-1.99], 1.09 [1.03-1.16] and 2.19 [1.38-3.80], respectively. The prevalence of carotid atherosclerosis in premenopausal women with SLE was 36.6%. Among these patients, a statistically significant association was found between occurrence of carotid atherosclerosis and dyslipoproteinemia, inflammation, and some lupus-related factors [duration of disease, SLICC damage score, cumulative dose of prednisone and duration of prednisone use]