International Journal of Scientific & Engineering Research, Volume 5, Issue 2, February-2014 ISSN

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1 ISSN Search For a Biomarker For The Diagosis Ad Progosis of Rheumatoid Arthritis Prasath G, Suil Rao Padmaraj, Vijayakumar T & Riju Mathew Abstract Rheumatoid Arthritis (RA) is oe of the commoest systemic autoimmue disease. Diagosis of Rheumatoid Arthritis is based o the detectio of Rheumatoid factor (RF) ad Ati cyclic citrulliated peptide Atibody (ACCP).But these markers have limited use i predictig the progosis of the disease. Hematological ad Iflammatory markers are idicators of disease activity. of the various biomarkers would be beeficial i effective treatmet ad maagemet of the coditio.a attempt is beig made to correlate the covetioal markers like RF ad ACCP with the ewer marker Ati Sa Atibody (Ati Sa) ad hematological parameters such as Hemoglobi (Hb), Red cell Distributio Width (RDW) ad Erythrocyte Sedimetatio Rate (ESR).It was observed that these parameters together serve as better biomarkers for the diagosis ad progosis of RA. Idex terms Rheumatoid Arthritis, Ati Sa Atibody, Ati cyclic citrulliated peptide (ACCP), Rheumatoid factor(rf), Chemilumiescece microparticle Immuoassay (CMIA),Immuoephelometry,Red cell distributio width (RDW),Erythrocyte sedimetatio rate (ESR),haemoglobi (Hb) xxx Itroductio Rheumatoid arthritis is oe of the commoest There are studies idicatig a positive correlatio betwee autoimmue disorders affectig the joits causig mild RDW,ESR & CRP i Rheumatoid Arthritis 6,7. Aemia is iflammatio to serious complicatios. Detectio of also cosidered to be factor leadig to low haemoglobi Rheumatoid factor was cosidered as the diagostic tool cocetratios which i tur could affect the red cell util the more specific markers like cyclic citrulliated distributio width 8.As oe of these markers idividually peptide atibodies(accp) were discovered 1,2. ACCP is is foud useful i diagosis ad progosis, the preset ow cosidered as oe of the very specific marker for RA. study was udertake to evaluate the covetioal ad But most of these markers has very poor progostic value ew biomarkers i Rheumatoid Arthritis patiets. ad ofte preset i detectable amouts eve after appropriate treatmet ad maagemet 3. Recetly, a ew Materials ad Methods immuological marker Ati Sa was discovered which has The study was carried out at Educare Istitute of Detal Scieces. very high specificity for RA with relatively low sesitivity Twety cliically prove cases of RA as per America whe compared to RF & ACCP 4. There are studies which highlights the progostic sigificace of Ati Sa especially college of Rheumatology (ACR) criteria form the test group. Twety age ad sex matched subjects selected from i the diagosis ad maagemet of cases of erosive arthritis 5. Hematological abormalities especially high the sibligs ad the staff of the hospital form the cotrol group. Noe of the patiets were sufferig from ay ESR ad icreased levels of iflammatory markers like C disease other tha RA while the cotrol subjects had o Reactive protei (CRP) ad fibrioge is also associated with RA. chroic or acute illess, autoimmue disease ad was ot o ay medicatio. Blood samples were collected from all the subjects after obtaiig their iformed coset ad the Prasath.G is curretly pursuig PhD degree program at Yeepoya followig ivestigatios were carried out. Haemoglobi & Uiversity: prasathg4u@gmail.com RDW usig Sysmex KX 21 aalyser,esr by Westergres Dr Suil rao Padmaraj is curretly,professor, Research guide & HOD method RF, by Immuoephelometry o Siemes BN Microbiology at Yeepoya Uiversity Prospec aalyzer, Ati CCP o Abbott Architect Dr Vijayakumar T isprofessor,research guide &Chief of Basic Medical Chemilumiescece microparticle Immuoassay aalyzer Scieces at Educare Istitute of detal Scieces Riju Mathew is curretly pursuig PhD degree program at Yeepoya ad Ati Sa by Euroimmu ELISA. Uiversity: The results were aalysed usig Miitab & SPSS statistical software. 2014

2 ISSN Results ad Discussio 20 patiet samples were aalyzed for Ati Sa, ACCP ad RF durig a three moth period.20 age ad sex matched cotrols were also icluded. Female costituted 77.5% of the patiets ad cotrols.(fig 1) Fig 1 All the patiets were i the age group yrs. The age wise distributio is explaied i Fig 2 cases respectively.table 1 elaborates the descriptive statistics of the paramters. There was sigificat correlatio betwee the Ati-Sa, ACCP, ad RF (p<0.01).(table 2) Cliical utility of Ati Sa & Ati cyclic citrulliated Atibody was foud to be sigificat i the earlier studies by Rodriguez etal & Prasath etal.hematological aalysis revealed elevated RDW ad ESR ad decreased hemoglobi i RA patiets compared to ormal cotrols. Hemoglobi levels showed sigificat egative correlatio with all the serological markers. The low hemoglobi levels could be a cosequece of aemia i RA patiets as suggested by Lippi etal & Woog etal RDW was foud to be correlatig well with the cliical coditio of the patiet. Optimal maagemet of the patiets with RA requires a careful evaluatio of the patiet for a suitable marker which will help i the predictio of progosis. Biomarkers are of immese use i various chroic coditios.but ufortuately o biomarker(s) has bee proposed adequately to assess the disease activity i RA. The covetioal markers like RF ad CRP were sigificatly elevated ad showed good correlatio with the ACCP. The ew serological marker Ati Sa had very high specificity with comparatively low sesitivity. RDW which is reported as a promisig marker for real ivolvemet may also be useful whe used i cojuctio with the covetioal ad ew serological markers. Table 1 Descriptive Statistics Mea Std. Deviatio N ACCP ANTI SA RA RDW ESR Hb Biochemical ad immuological parameters of the patiets ad that of the cotrols were statistically aalysed. Out of 40 subjects (both patiets ad cotrols) (25%) were Ati Sa-positive, (45%) ACCP-positive ad (50%) were positive for RF, while i RA patiets, Ati Sa, ACCP ad RF were positive i (50%), (75%) ad (80%) 2014

3 ISSN Table 2 s ACC P ANT I SA RA Pearso ACC ANT RD P I SA RA W ESR Hb Sig. ( Pearso Sig. ( Pearso Sig. ( Fig Sig. ( RDWPearso ESR Pearso Hb Sig. ( Pearso Sig. ( is sigificat at the 0.01 level (2-.. is sigificat at the 0.05 level (2-. Fig

4 ISSN Fig 5 Fig 7 Fig 6 Fig 8 Coclusio The serological markers Ati Sa Atibody,Ati cyclic citrulliated peptide atibody & Rheumatoid factor i combiatio serves as good serological markers for Rheumatoid Arthritis. The hematological markers RDW, hemoglobi ad ESR reflects the pathological outcomes of Rheumatoid Arthritis. The hematological abormalities like aemia might be a factor ivolved i these variatios.nevertheless the hematological parameters i cojuctio with the serological markers aids i the diagosis of Rheumatoid Arthritis Referece 2014

5 ISSN Iala L, Kokkoe H, Eriksso C, Jidell E, Bergli E, Dahlqvist SR. Atibodies agaist mutated citrulliated vimeti are a better predictor of disease activity at 24 moths i early rheumatoid arthritis tha atibodies agaist citric citrulliated peptides.j Rheumatol 2008;35: Ioa-Facsiay A, Willemze A, Robiso DB, et al. Marked differeces i fie specificity ad isotype usage of the ati-citrulliated protei atibody i health ad disease. Arthritis Rheum 2008;58: Prasath G, Suil Rao Padmaraj, Riju Mathew ad Vijayakumar T Cyclic citrulliated peptide Atibody & Rheumatoid factor as diagostic markers of Rheumatoid Arthritis. ICGP 2011;pp Prasath G, Suil Rao Padmaraj, Riju Mathew ad Vijayakumar T Ati-Sa Atibody, Cyclic Citrulliated Peptide Atibody Ad Rheumatoid Factor As Diagostic Markers Of Rheumatoid Arthritis. 2013:Vol 4 issue 2 5. Rodriguez-Mahou M, López-Logo FJ, Sachez-Ramo S, Estecha A, Garcia-Segovia A, Rodriguez-Molia JJ, Carreo L, Feradez-Cruz E (2006) Associatio of ati-cyclic citrulliated peptide ad ati-sa/citrulliated vimeti autoatibodies i rheumatoid arthritis. Arthritis Care Res 55: Toelli M, Sacks F, Arold M, Moye L, DavisB, Pfeffer M. Relatio betwee red blood cell distributio width ad cardiovascular evet rate i people with coroary disease. Circulatio. 2008;117(2): Perlstei TS, Weuve J, Pfeffer MA, Beckma JA. Red blood cell distributio width ad mortality risk i a commuity-based prospective cohort. Arch Iter Med 2009;169(9): Matsui T, Kuga Y, Kaeko A, et al. Disease Activity Score 28(DAS28) usig C-reactive protei uderestimates disease activity ad overestimates EULAR respose criteria compared with DAS28 usig erythrocyte sedimetatio rate i a large observatioal cohort of rheumatoid arthritis patiets i Japa. A Rheum Dis. 2007;66(9): Nurmohamed MT. Cardiovascular risk i rheumatoid arthritis. Autoimmu Rev. 2009;8(8):