INTRODUCTION : Rheumatoid Arthritis (RA) is the most common systemic inflammatory, auto immune Rheumatic disease of unknown etiology affecting nearly 1% of the adult population worldwide. It is characterized by chronic and erosive polyarthritis, (usually involving small, peripheral joints in a symmetric distribution) caused by abnormal growth of synovial tissue or pannus, and causes irreversible joint deformity that can lead to severe disability with considerable morbidity. Although the precise aetiology of RA remains unknown, there is strong evidence for autoimmunity, since several auto antibodies are associated with the disease. The potential of the synovial inflammation to cause cartilage damage and bone erosions and subsequent changes in joint integrity is the hallmark of the disease. Despite its destructive potential, the course of RA can be quite variable. Some patients may experience only a mild oligo articular illness of brief duration with minimal joint damage, but most will have a relentless progressive polyarthritis with marked functional impairment. AIMS AND OBJECTIVES : Aim: The aim of the present study is to evaluate the use and significance of AntiCCP antibodies in Rheumatoid Arthritis, and to compare it with other Arthritis - Early Synovitis (ES), Connective
Tissue Disorders (CTD) including SLE, and Osteo Arthritis (OA), and in Healthy Blood Donors as control.
Objectives: • To evaluate the diagnostic utility of Anti- CCP (cyclic citrullinated peptide) antibody in Rheumatoid arthritis. • To study & compare the presence of Anti- CCP antibody in Rheumatoid arthritis (RA) with other arthritis. – Early Synovitis (ES),Connective Tissue Disorders (CTD) including SLE, and Osteo Arthritis (OA).
• To evaluate the significance of Anti- CCP antibody in Sero Negative Rheumatoid Arthritis. • To assess the sensitivity and specificity of the Anti CCP antibody test with RF test in RA and other arthritis. MATERIALS AND METHODS : The total number of subjects in this study for evaluation were 250, which included both males and females.The study subjects were selected according to the inclusion criteria’s mentioned below, from the
patients who attended the Out Patient Clinics at the Rheumatology and Orthopaedics Department and Healthy Blood Donors who attended the Blood bank, Coimbatore Medical College Hospital, Coimbatore. The study subjects, in both genders were divided into five groups. Each group include 50 patients. Four groups based upon the clinical conditions and fifth group, healthy individuals (blood donors) as control, as follows: Group I: Rheumatoid Arthritis (RA) - 50 patients. Group II: Early Synovitis (ES) - 50 patients. Group III: Connective Tissue Disorders including Systemic Lupus Erythematosus (SLE) - 50 patients. Group IV: Osteo Arthritis (OA) - 50 patients, and Group V: Healthy Blood Donors (HBD) - 50 patients. Inclusion Criteria: Early Synovitis: Patients with complaints of joint pain. (Synovitis – joint pain, blotted feeling, redness, fever for > 6wks & < 12
months duration.) • Joint pain with no h/o injury or sepsis. • Without any bony deformity. • Not already on treatment for RA. (Inclusion19of patients fulfiling ≥ 2 clinical and ≥1 laboratory criterion and duration of symptoms ≤ 12 weeks. Exclusion Criteria: RA: If does not fit in to the ACR criteria. Early Synovitis: • Complaints of joint pain (synovitis 12months). • Joint pain with h/o injury or sepsis. • With bone and joint deformity. • Already on treatment for RA. RESULTS : The present study was conducted with the patients who attended the Out Patient Clinics at the Rheumatology and Orthopaedics Department of Coimbatore Medical College Hospital, Coimbatore. 200 subjects (including both males and females) were recruited for the study. The subjects were categorized into four groups – RA, ES, CTD, and OA (each group 50) based upon the clinical conditions, and 50 Healthy Blood Donors who attended the Blood bank, Coimbatore Medical College Hospital, Coimbatore, were selected as control and categorized into fifth group. CONCLUSION : In conclusion, based upon the higher sensitivity and specificity of the Anti CCP test in RA, the current study is of diagnostic, and public importance, because it suggests that Anti CCP test should be included in the investigation of undifferentiated arthritis, since a considerable amount of Rheumatic disease associated work disability starts in the first few years of the disease. Anti-CCP antibodies have all the hallmarks of establishing themselves firmly in the diagnostic algorithm of Rheumatoid Arthritis providing additive sensitivity to Rheumatoid Factor. So it should also be included among the diagnostic criteria of RA along with RF. It can also be used as a prognostic indicator in RA patients on treatment
