Romatoid Artritli Hastalarda Anti-sa Antikorunun Tanısal ve Prognostik Değeri

Abstract

Amaç: Romatoid artritli ( RA) hastalarda Anti-Sa (Anti-sitrüline vimentin ) otoantikorunun, tanısal değerini, hastalık aktivitesi ve radyolojik hasar ile ilişkisini araştırmayı amaçladık. Metod: Çalışmaya ACR/ EULAR 2010 RA sınıflama kriterlerine göre 69 RA hastası ve hasta grubu ile yaş ve cinsiyet açısından uyumlu 50 sağlıklı kontrol alındı. Çalışmaya katılan hastalara başlangıçta ve 3.ayda klinik ve laboratuar değerlendirme yapıldı. Hastalık aktivitesinin değerlendirilmesinde DAS28, klinik hastalık aktivite indeksi (CDAİ), basitleştirilmiş hastalık aktivite indeksi (SDAİ), kullanıldı. Ağrı vizüel analog skala (VAS), fonksiyonel durum HAQ (Sağlık Değerlendirme Anketi), yaşam kalitesi ise kısa-form (SF)-36 ile değerlendirildi. Hastaların el radyografıleri başlangıçta Modifiye Total Sharp Skoru (mTSS) kullanılarak değerlendirildi. Hasta ve kontrol grubundan başlangıçta RF ve Anti-CCP bakıldı. Anti Sa için kan örnekleri hasta grupta başlangıç ve 3. ay, kontrol grubu için ise bir kez alınarak serumlarına ayrıldı ve örnekler analiz gününe kadar -80°C'de saklandı. EUROIMMUN SA-Antibodies ELİSA kiti kullanılarak çalışıldı. Bulgular: RA'lı hastaların 25'inde (%36.2) anti-Sa pozitif saptandı. 24 hastada(%34.7) anti-CCP ve anti-Sa , 19 hastada (%27,5) ise RF ve anti-Sa birlikte pozitifken, sadece 1 hastada izole anti-Sa pozitifliği kaydedildi. 36 hastada (%52.2) RF pozitif, 42 hastada (%60.9) anti-CCP pozitif bulundu. Kontrol grubunda anti-Sa pozitifliği bulunmazken, bir hastada RF ve anti-CCP pozitif saptandı. Anti-Sa'nın tanısal duyarlılığı(sensitivite) %56.8, özgüllüğü(spesifite) %100, pozitif prediktif değeri %100, negatif prediktif değeri %79.7, anti-CCP 'nin tanısal duyarlılığı %83.7, özgüllüğü %84.1, pozitif prediktif değeri %70.4, negatif prediktif değeri %92 olarak belirlendi. Anti-Sa pozitif hastalarda ortalama RF ve anti-CCP değerleri anti-Sa negatif hastalardan istatistiksel anlamlı olarak daha yüksek kaydedildi(sırasıyla p =0.019, p=0.0001). Hastalar RF, anti-CCP ve anti-Sa'nın her üçünün de pozitif olduğu (18 hasta) ve negatif olduğu ( 19 hasta) iki gruba ayrıldı. Gruplar arasında başlangıç ve 3.ayda ESR, CRP, DAS28, CDAİ, SDAİ, VAS ve HAQ skorları açısından istatistiksel anlamlı fark bulunmadı. Hastalık aktivitesi değişim oranları karşılaştırıldığında üç antikor pozitif grupta daha fazla düzelme olmasına rağmen 2 grup arasında istatistiksel anlamlı fark saptanmadı. Grup içi değerlendirmede ise her iki grupta sabah tutukluğu(ST) dışında diğer değişkenlerde 3.ayda istatistiksel anlamlı fark yoktu. Anti Sa pozitif hastalarda SF-36 değişkenlerinden fiziksel fonksiyon (p <0.001), fiziksel rol (p <0.01), vücut ağrısı (p <0.05), zindelik (p <0.05) subskorlarında istatistiksel anlamlı fark bulundu. SF-36'nın diğer değişkenlerinde anlamlı fark yoktu. Anti-CCP ve anti-Sa'nın pozitif olduğu hastalar ile negatif olduğu hastaların Modifiye Total Sharp Skorları karşılaştırıldığında istatistiksel anlamlı fark bulunmadı. Sonuç: Anti –Sa'nın özgüllüğü(%100) ve pozitif prediktif değerini ( %100) anti-CCP den ( %84.1, 70.4) daha yüksek saptandı. Anti- Sa pozitifliği ile SF-36'nın bazı alt parametreleri dışında hastalık aktivitesi ve prognoz arasında ilişki saptanmadı. RA hastalarında anti-Sa, anti-CCP'ye ek olarak tanısal test olarak kullanılabilir. Anahtar kelimeler: Romatoid Artrit(RA) , anti-CCP, anti-Sa, RF (Romatoid faktör)Diagnostic and Prognostic Value of Anti-Sa Antibody in Patients with Rheumatoid Arthritis Purpose: Our purpose was to research the diagnostic value of Anti-Sa (Anti-citrullinated vimentin) autoantibody and its association with disease activity and radiological damage in patients with rheumatoid arthritis (RA). Method: 69 patients with RA based on ACR/ EULAR 2010 RA classification criteria and 50 healthy controls who were age and gender matched with the patient group were included in the study. The patients who participated in the study were assessed clinically and in terms of laboratory results at the beginning of the study and in the third month. DAS28, clinical disease activity index (CDAI) and simplified disease activity index (SDAI) were used to assess disease activity. Pain was assessed with visual analog scale (VAS), functional state was assessed with HAQ (Health Assessment Questionnaire) and quality of life was assessed with short-form (SF)-36. Hand radiographies of the patients were assessed by using Modified Total Sharp Score (mTSS) at the beginning of the study. RF and Anti-CCP were checked in the patient and control group at the beginning of the study. Blood samples were taken at the beginning of the study and in the third month for the patient group while they were taken only once for the control group. The samples were put in serums and they were kept at -80°C until the day of the analysis. EUROIMMUN SA-Antibodies were studied by using ELİSA kit. Results: In 25 (36.2%) of the patients with RA, anti-Sa was found to be positive. In 24 (34.7%) patients, anti-CCP and anti-Sa were found to be positive, while in 19 (27,5%) patients, RF and anti-Sa were found to be positive. In only 1 patient, isolated anti-Sa positivity was recorded. In 36 (52.2%) patients, RF was found to be positive while anti-CCP was found to be positive in 42 (60.9%) patients. No anti-Sa positivity was found in the control group; however, RF and anti-CCP was found to be positive in one patient. For Anti-Sa, diagnostic sensitivity was 56.8%, specificity was 100%, positive predictive value was 100% and negative predictive value was 79.7%; for anti-CCP, diagnostic sensitivity was 83.7%, specificity was 84.1%, positive predictive value was 70.4% and negative predictive value was 92%. In patients who had Anti-Sa positive, average RF and anti-CCP values were found to be statistically significantly higher than those of the patients with anti-Sa negative (p =0.019, p=0.0001, respectively). The patients were grouped in two as those who had RF, anti-CCP and anti-Sa positive (18 patients), and those who had RF, anti-CCP and anti-Sa negative (19 patients). No statistically significant difference was found between groups in terms of the ESR, CRP, DAS28, CDAİ, SDAİ, VAS and HAQ scores at the beginning of the study and in the third month. When rates of change in disease activity were compared, although more progression was found in the group with three antibodies positive, no statistically significant difference was found between the two groups. In terms of in-group assessment, there was no statistically significant difference between variables except for ST in the third month in both groups. In patients with Anti-Sa positive, statistically significant difference was found in physical function (p <0.001), physical role (p <0.01), body pain (p <0.05) and fitness (p <0.05) sub scores of SF-36 variables. No significant difference was found in the other variables of SF-36. No statistically significant difference was found between the Modified Total Sharp scores of patients with Anti-CCP and anti-Sa positive and patients with Anti-CCP and anti-Sa negative. Conclusion: Specificity (100%) and positive predictive values (100%) of Anti-Sa were found to be higher than those of anti-CCP (84.1% and 70.4%, respectively). Except for Anti-Sa positivity and some of the sub parameters of SF-36, no association was found between disease activity and prognosis. In patients with RA, anti-Sa can be used as a diagnostic test in addition to anti-CCP. Key Words: Rheumatoid arthritis (RA), anti-CCP, anti-Sa, RF (Rheumatoid factor)