• 8
    Nov
  • Diagnostic Value and Clinical Significance: RESULTS

We analyzed data from 76 RA patients and 83 controls. The two groups were similar with respect to percentages of female gender (88% and 90% for patient and control groups, respectively) and mean ages (53.0 ± 10.8 and 54.1 ± 11.3 years, respectively). The most common treatments received by RA patients were chloroquine, methotrexate 2,5 mg and their combinations with other DMARD. The clinical and laboratory variables and the detailed characteristics of the RA patients were shown in Table 1.

Table 1. Characteristics and the clinical and laboratory variables in patients with advanced rheumatoid arthritis (n=76). Continuous variables are expressed as means ± SD. Numbers in parenthesis represent the percentages of total number of patients

Age (years) 53.07 ± 10.83
Number of male/female patients 9/67
Duration of disease (years) 9.82 ± 6.76
Morning stiffness (minutes) 36.51 ±52.13
Patient’s assessment of pain (100 mm VAS) 20.55 ± 20.35
Tender joint count (0-28) 4.42 ± 5.63
Swollen joint count (0-28) 0.92 ± 1.35
Presence of rheumatoid hand deformity 37 (48.7%)
HAQ score 0.25 ± 0.34
C-reactive protein (mg/dl) 2.14 ±2.85
RF (lU/ml) 120.98 ±217.01
Anti-CCP (RU/ml) 33.85 ± 50.55
ESR (mm/1 st h) WBC (1000/mm3) 41.65 ±30.04
7.54 ± 2.23
PLT (1000/mm3) 280.73 ± 92.89
Hb (g/l) 12.23 ± 1.36
Number of Patients Taking One or More DMARD
Methotrexate drug 5 (6.6%)
Chloroquine 11 (14.5%)
Sulfasalazine 500 mg 1 (1.3%)
Leflunamid 3 (3.9%)
Remicade/methotrexate 3 (3.9%)
Chloroquine/sulfasalazine 3 (3.9%)
Chloroquine/methotrexate 7 (9.2%)
Drug Sulfasalazine/methotrexate 5 (6.6%)
Methotrexate/leflunamid 7 (9.2%)
Chloroquine/methotrexate/sulfasalazine 4 (5.3%)
DMARD: disease-modifying antirheumatic drug

Thirty-seven RA patients (48.7%) were found to be positive for anti-CCP, whereas only one (1.2%) had an anti-CCP-positive serum in the control group. RF was positive in 34 (44.8%) of the RA cases and in four (4.8%) of controls. The proportions of serum samples positive for anti-CCP and RF were significantly (p<0.001 for both) higher in patients with RA as compared with control subjects (Table 2).

Table 2. The comparison of anti-CCP and RF reactivities in the study groups

RA Patients (n=76) Controls (n=83)

P Value

Anti-CCP

Positive

Negative

37 (48.7%) 39 (51.3%) 1 (1.2%) 82 (98.8%)

O.001

RF

Positive Negative

34 (44.8%) 42 (55.2%) 4 (4.8%) 78 (95.2%)

O.001

Numbers in parenthesis represent the percentages of total numbers in corresponding patient and control groups.

At selected cut-off levels, sensitivity (49.0%) and specificity (99.0%) of anti-CCP reactivity for the diagnosis of RA were slightly higher than those of RF (46.0% and 95.0%, respectively). The area under the ROC curve was 0.73 (95% CI: 0.65-0.81) for anti-CCP and 0.68 (95% CI: 0.59-0.77) for RF.

We found a moderate correlation between the levels of anti-CCP and RF (r=0.57, pO.OOl). A detailed inspection of the distribution of anti-CCP and RF levels suggested that RA patients with anti-CCP levels >120 RU/ml constituted a distinct subgroup, with equally represented low and high RF values. How­ever, there were no statistically significant differences in terms of age, gender, disease duration and DMARD intake between this subgroup and the RA patients with anti-CCP levels <120 RU/ml. There were no patients with anti-CCP and RF levels <30 RU/ml and >350 IU/ml, respectively, and the distribution was skewed towards higher (>30 RU/ml) anti-CCP values (PO.05, McNemar test).
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Table 3. The relations of anti-CCP and RF positivities with clinical and laboratory variables in patients with advanced rheumatoid arthritis. Continuous variables are expressed as means ± SD

Anti-CCP Anti-CCP P RF RF P
Positive Negative Value Positive Negative Value
(n=37) (n=39) (n=34) (n=32)
Age (years)

55 ± 8.9

52 ± 12.3

NS

55.6 ±9.1

50.3 ± 12.0

0.018

Male/female (n)

31/6

36/3

NS

28/6

39/3

NS

Duration of disease (years)

10.2 ± 7.6

9.9 ± 6.5

NS

*   10.6 ±7.9

9.4 ± 5.2

NS

Morning stiffness (minutes)

54.3 ± 63.2

19.6 ±31.3

0.003

54.9 ± 63.9

21.7 ±34.4

0.005

VAS pain (mm)

30.1 ±29.4

19.7 ±20.6

NS

25.1 ±24.4

18.2 ±21.5

NS

Swollen joint count

1.35 ± 1.5

0.5 ± 1.0

0.006

1.2 ± 1.4

0.6 ± 1.2

0.038

Tender joint count

6.0 ± 6.4

2.8 ± 4.3

0.013

5.6 ± 6.0

3.2 ± 4.9

NS

HAQ

0.39 ± 0.32

0.18 ±0.20

0.001

0.31 ± 0.29

0.27 ± 0.25

NS

CRP (mg/dl)

2.8 ± 3.6

1.6 ± 1.9

NS

2.8 ± 3.5

1.6 ± 1.8

NS

ESR (mm/first hour) WBC (1,000/mm3)

51 ±31.9

33 ± 25.5

0.009

53 ± 32.4

31.9 ±23.8

0.01

7.7 ± 2.2

7.4 ± 2.3

NS

7.7 ± 2.0

7.4 ± 2.4

NS

PLT (1,000/mm3)

301 ±119.9

261 ±51.8

NS

303 ± 113.6

258 ± 59.8

0.049

Hb (g/l)

12.0 ± 1.5

12.4 ± 1.2

NS

12.0 ± 1.5

12.5 ± 1.2

NS

NS: not significant

The relations of anti-CCP and RF positivities with clinical and laboratory variables of the disease in univariate analysis are presented in Table 3. There were no significant differences in anti-CCP and RF positivities with respect to gender, VAS, CRP, WBC and Hb values. On the other hand, anti-CCP and RF positivities were found to be significantly associated with duration of morning stiffness, swollen joint counts and ESR values in patients with RA. Although there was no relation between anti-CCP and age, the patients who were positive for RF were older than those who were negative. The tender joint counts were significantly higher in anti-CCP positive than anti-CCP negative patients (6.0 ± 6.4 and 2.8 ± 4.3, respectively). In addition, anti-CCP positive RA patients had more functional disability than anti-CCP negative ones according to HAQ (Table 3). Viagra Super Active

Table 4. Independent predictors of anti-CCP positivity in patients with advanced rheumatoid arthritis (logistic regression, dependent variable: anti-CCP positivity)

В                    SE                      OR (95% CI)

HAQ                                    3.04                 1.15                 20.99 (2.21 -109.14) Duration of morning stiffness     1.66                0.52                 5^25 (1.68-16.35)

P Value

0.008 0.004

B: logistic regression coefficient, SE: standard error, OR: odds ratio, CI: confidence interval

The forward conditional logistic regression analysis with the variables significantly associated with anti-CCP and RF positivities in univariate analysis (i.e., duration of morning stiffness, swollen joint counts and ESR values) showed that HAQ score and the duration of morning stiffness were the independent predictors of anti-CCP positivity in patients with advanced RA (Table 4). tricor cholesterol

Table 5. Independent predictors of the presence of rheumatoid hand deformity in patients with advanced rheumatoid arthritis (logistic regression, dependent variable: presence of rheumatoid hand deformity)

В SE OR (95% CI)

P Value

Duration of disease

0.64

0.22

1.89 (1.22-2.94)

0.004
Swollen joint count

1.97

0.68

7.21 (1.90-27.42)

0.004
Anti-CCP

0.32

0.01

1.03 (1.00-1.06)

0.023

The rheumatoid hand deformity was present in 37 (48.7%) RA patients (Table 1). The presence of hand deformity was taken as the primary outcome measure related to the severity of the disease. In logistic regression analysis where the presence of hand deformity was the dependent variable, duration of disease, swollen joint count and anti-CCP positivity were found to be the independent predictors (Table 5).

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