Dissertation committee:
Ομότιμος Καθηγητής κ. Σφηκάκης Παύλος, Ομότιμος Καθηγητής κ. Μαυρικάκης Μύρων, Αναπληρώτρια Καθηγήτρια κα Οικονομίδου Ιωάννα
Summary:
Rheumatoid Arthritis (RA), the most commonly occurring autoimmune disorder, if
untreated leads progressively to permanent joint damage and disability.
The aim of this study is the detection and measurement of biomarkers and
autoantibodies in Greek patients with RA, the evaluation of their role in the
diagnosis of RA and the prediction of the evolution of RA.
Material and methods: A total of 426 patients were included in the study. Of
those 278 were diagnosed as having RA (group A) and 148 suffered from other
autoimmune or inflammatory diseases (group B). Moreover, 32 blood donors were
included as healthy controls. The laboratory tests applied in the serum samples
included: 1) the measurement of Rheumatoid Factor (RF), of C-Reactive Protein
(CRP) and of complement factors C3, C4 by nephelometry, 2) the titration of
antinuclear (ANA) and anti-double stranded DNA (anti-dsDNA) using indirect
immunofluorescence, 3) the detection of autoantibodies to extractable nuclear
antigens (anti-ENA) using ELISA and Immunoblotting, and 4) the anti-RA33,
anti-CCP2, anti-CCP3.1, anti-MCV antibodies and the RF IgG, IgM and IgA
classes, using ELISA.
Results: a) the presence of positive ANA and anti-RA33 antibodies or of
abnormal CRP values does not differ significantly between the two groups, b)
there was no significant difference in the percentages of positive anti-Ro
antibodies between the two groups, however the investigation of the specificity
of the anti-Ro antibodies showed a higher percentage of anti-Ro52 antibodies in
the group A samples in comparison with group B (p= 0.025), c) the percentage of
RA patients with positive anti-CCP2, anti-CCP3.1, anti-MCV antibodies and
abnormal RF values was significantly higher in group A in comparison to group B
(p< 0.001). Concerning the criteria of sensitivity and specificity it was
shown that anti-CCP2 antibodies have a higher sensitivity, whereas anti-MCV
antibodies presented a higher specificity compared to the other markers, d)
regarding the evolution of the prospective cohort of patients with
undifferentiated arthritis which evolved into RA (within a six months period)
it was shown that anti-CCP2, anti-CCP3.1 and anti-MCV antibodies had a
significant prognostic value, e) a positive correlation was found with the
index for disease activity (DAS28) and the levels of anti-MCV antibodies
(r=0.69, p<0.001), and f) the investigation of the effect of treatment in
patients with RA and follow up for a 2 years period showed no significant
change in the levels of any of the parameters studied following treatment
interventions.
Conclusions: The combination of RF and anti-CCP2 is of great importance for the
diagnosis, prognosis and prediction of the course of RA, moreover the anti-MCV
antibodies represent the most important marker for assessing disease activity.
Keywords:
Rheumatoid Arthritis, Anti- CCP2 antibodies, Rheumatoid Factor, Anti- CCP3.1 antibodies , Anti- MCV antibodies
