الفهرس 
Anti-citrullinated peptide antibodiesOnly 14 pages are availabe for public view
 |  | from | 32 |  |  |
| | | from | 32 | | |
Abstract
Rheumatoid arthritis (RA) is a common chronic inflammatory autoimmume disease affecting approximately 1% of the world population. The synovium of small joints hands and feet is the first affected structure. The inflammatory changes lead subsequently to cartilage destruction and bone deformities.
RA is characterized by the presence of ACPA (anti-citrullinated peptide/protein antibodies) which has been included in the 2010 RA classification criteria. The standard test for these antibodies is the second-generation CCP (CCP2) test, which is one of the best in terms of sensitivity and specificity. The involvement of ACPA in the chronicity of RA is probably the reason why ACPA-positive patients have a more erosive disease course than ACPA-negative patients.
RA is associated with a wide range of cardiovascular (CV) manifestations, including atherosclerosis, thrombosis, heart failure, valvular heart disease, arrhythmia, aortic aneurysms, myo-, peri- and endocarditis, vasculitis, rheumatoid cardiac nodules, and cardiac amyloidosis.
The importance of ACPA in CVD is supported by its link to CV risk also in the general population. However, it is still unclear if these antibodies themselves enhance the CV risk, or if they are bystanders of other, pathogenic, factors, such as inflammatory burden.
This study was designed to evaluate the association between anticyclic citrullinated peptide antibodies and adverse cardiovascular profile in established rheumatoid arthritis patients as documented by carotid intima medial thickness and abnormal echocardiography.
In the present study 60 patients who fulfilled the 2010 ACR/EULAR classification criteria for RA were recruited. The selected patients were classified according to ACPA positivity into 30 seropositive and 30 seronegative RA patients. The patients were also classified into patients with cardiovascular involvement (echocardiographic abnormalities and/or carotid Doppler abnormalities) and patients without cardiovascular involvement.
Full laboratory assessment was done including CBC, ESR, CRP, RF, Anti CCP, Lipid profile, Liver enzymes, Serum creatinine, BUN, X-ray hands. This was followed by assessment of disease activity using DAS28. Echocardiography and carotid Ultra sonogram Doppler to measure intima media thickness were also done.
In this study cardiovascular abnormalities including echocardiography abnormalities, increased carotid intimal thickness and carotid plaques were significantly higher among cases with positive ACPA than among cases with negative ACPA in addition to increase mean of ACPA titre in patients with cardiovascular abnormalities in comparison to patients without cardiovascular abnormalities.
In our study there was significant negative correlation between ACPA and steroid cumulative dose in positive ACPA group. While Larsen score was significantly higher among cases with positive ACPA than among with negative ACPA.
In the current study duration of RA were significantly higher among cases with positive ACPA than among with negative ACPA.
In the current study age of patients, duration of RA, duration of steroid use, Larsen score, serum cholesterol and triglyceride (TGA), were significantly higher among cases with cardiovascular abnormalities than among those without cardiovascular abnormalities.
However in this study frequency of patients with sulfasalazine (SLZ) use or any biological use were significantly lower among cases with positive cardiovascular abnormalities.
While duration of RA and ACPA increases the likelihood of having a cardiovascular abnormality, HCQ and SLZ were found to decrease the likelihood of having a cardiovascular abnormality.