THE ROLE OF ACUTE-PHASE REACTANTS IN PATIENTS WITH RHEUMATOID ARTHRITIS
Radiographic evaluation is still the most important tool for assessing structural damage to joints and the skeleton. The progression of the radiographic damage to the joints in the hands and feet is an important and objective variable for assessing the disease's activity as well as predicting the outcomes of treatment. In this study, radiographic assessment of the hand joints, acute phase reactants (ESR and CRP), and ACPA autoantibodies were used to assess the disease activity in RA patients treated with methotrexate therapy. Their roles as prognostic indicators of disease outcome were also examined. The serum of 70 participants (35 in the untreated RA group and 35 in the control group) was tested using the ELISA method DIA-STATTM Anti-CCP (Axis-Shield Diagnostics). In the same participants, RF was determined using the agglutination test (Latex RF test). Patients were treated with methotrexate at an average dose of 10 mg once weekly. For clinical evaluation of disease activity in every patient's radiographic index (RI), sedimentation, CRP, and RF were analyzed at certain time intervals (baseline, after 6, 9, and 12 months). The dynamic changes in the mean values of the RI score, sedimentation, CRP, and RF were used to assess RA. RI showed an increased radiographic progression of hand joint damage at time intervals between baseline and 9 months (p = 0.0167) and between baseline and 12 months (p = 0.0089). Statistical analysis showed statistically significant differences among the mean values of ESR in the four time intervals (p = 0.00002). Also, statistically significant differences were shown in the mean values of CRP in the four time intervals (p = 0.0488) (standard deviations showed great variations). At baseline, progression was seen in 3 (10%) patients, after 6 months in 13, and after 9 and 12 months RI progression was seen in 15. It was also observed that most patients had increased values of RF and CRP. Despite the methotrexate therapy, progression of the radiographic damage followed, especially in patients with increased values of sedimentation, CRP, and RF with persistence of previous hand joint erosions, as predictors of the aggressive course of disease.
Keywords: Rheumatoid arthritis, Rheumatoid factor, Reactants of the acute phase.
2.Williams AL, O'Sullivan MM, Lewis PA, Coles EC, Jessop JD. Relationship between time-integrated c-reactive protein levels and radiologic progression in patients with rheumatoid arthritis. Arthritis Rheum 2000 ; 43 : 1473-1477.
3.Kremer JM, Phelps CT. Long - term prospective study of the use of methotrexate in the treatment of rheumatoid arthritis: update after a mean of 90 months. Arthritis Rheum 1992; 35: 138- 45.
4.Strand V, Sharp JT Radiographic data from recent randomized controlled trials in rheumatoid arthritis. Arthritis Rheum 2003; 48: 21-34.
5.Visser H, le Cessie S, Vos K, Breedveld FC, Hazes J. How to diagnose rheumatoid arthritis early: a prediction model for persistent( erosive) arthritis. Arthitis rheum 2002; 46: 357-65.
6.Redlich K, Hayer S, Ricci R. Osteoclasts are essential for TNF-a-mediated joint destruction. J Clin Invest 2002; 110:1419-27.
7.Hoekstra M,van Ede AE, Haagsma CJ. Factors associated with toxicity, final dose, and efficacy of methotrexate in patients with rheumatoid arthritis. Ann Rheum Dis 2003; 62: 423-6.
8.Jansen LMA, van der Horst - Bruinsma IE, van Schaardenburg D, Bezemer PD, Dijkmans BAC. Predictors of radiographic join damage in patients with early rheumatoid arthritis. Ann Rheum Dis 2001; 60: 924-027.
9.Michael JP, Arnold LW, O'Sullivan MM, Lewis PA, Coles EC, Jessop JD. Relationship between time- integrated c- reactive protein levels and radiologic progression in patients with rheumatoid arthritis. Arthritis Rheum 2000; 43 : 1473 - 1477.