ДИАГНОСТИЧЕСКАЯ ЗНАЧИМОСТЬ СЕРОЛОГИЧЕСКИХ МАРКЕРОВ РЕВМАТОИДНОГО АРТРИТА

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<ul><li><p>20</p><p>- 2012; 54(5): 2024</p><p> , -</p><p> (), </p><p> , , - . , </p><p>1- -- - - . . .. -; 2 - - , - . .. -; 3-- - - - -; 4 - -; 5-- - . </p><p>1Research Guidance Centerof Molecular Medicine, St.Petersburg State MedicalUniversity named afterAcademician I.P. Pavlov;2Federal State BudgetaryInstitution V.A. AlmazovFederal Center for Heart,Blood and Endocrinology;3St. Petersburg MedicalAcademy of PostgraduateEducation, Federal Agencyfor Healthcare and SocialDevelopment;4Leningradskaya RegionalClinical Hospital; 5ScientificResearch Institute ofEpidemiology andMicrobiology named afterPaster</p><p>: - esc_4@mail.ru</p><p>Contact: AlekseiLeonidovich Maslyanskiesc_4@mail.ru</p><p> 14.03.12</p><p> .. 2, .. 1, .. 1, .. 1, .. 1, .. 2, .. 2, .. 4, .. 5, .. 3</p><p> () , - , . () RA33, () IgA . . 253 , , - . 92 : -, , , . IgM IgA , - (), , (), RA33-- (ARA33) () . . 78%, 77%, IgM 71%, IgA 43%, 43%, RA33 31% 31%. (, , ) IgM. 24% 20 / 21% 30 /, 91%. RA33 , , . C - 87,9%, .. RA33 - . : , , , -, , , , RA33. </p><p>DIAGNOSTIC VALUE OF RA SEROLOGICAL MARKERS OF RHEUMATOID ARTHRITISA.L. Maslaynski2, S.V. Lapin1, A.V. Mazing1, T.V. Bulgakova1, N.M. Lazareva1, M.D. Cheshuina2, P.A. Oleinick2, E.P. Ilivanova4, A.A. Totolyan5, V.I. Mazurov3</p><p>Rheumatoid arthritis (RA) is a classic autoimmune disease associated with the production of wide range of autoanti-bodies, and their detection has diagnostic and prognostic implication. The objective of this study was to estimate the diagnostic value of antibodies against modified citrullinated vimentin(AMCV) and nuclear antigen RA33 of the IgA rheumatoid factor (RF) versus the value of routinely used profile ofautoantibodies in diagnostic work-up of RA.Material and methods. 253 patients with RA prehistory of varying duration were included into the study group. Thecontrol group was comprised of 92 patients, including patients with seronegative spondyloarthropathies and diffuseconnective tissue diseases, as well as sex and age matched healthy controls. Serum levels of IgM and IgA RF, antibod-ies against cyclic citrullinated peptide (ACCP), ACMV, anti-keratin antibodies (AKA), antibodies against RA33 anti-gen (ARA33) and antinuclear factor (ANF) were measured in all patients and controls.Results and discussion. Diagnostic sensitivity of AMCV equaled 78%, ACCP 77%, IgM RF 71%, IgA RF 43%,AKA 43%, ARA33 31% and ANF 31%.All anti-citrullinic antibodies (AKA, ACCP, ACMV) were significantly more commonly associated with IgM RF.Among RF and ACCP seronegative patients ACMV were found in 24% cases with 20 IU/Ml detection threshold, andin 21% with 30 IU/Ml, allowing to increase diagnostic specificity of the test up to 91% with the increment of diag-nostic threshold.Incidence of ARA33 was not significantly different among the RF and ACCP positive or negative subgroups, thusmaking ARA33 an independent RA marker. Specificity of this marker was 87,9%, thus making it inferior to RF andACCP by a composite of diagnostic characteristics.Conclusions. Integrated measurement of ACMV and ARA33 is a rational approach at the second stage of serologictesting work-up in suspected cases of RA onset, when initial RF and ACCP tests were negative.Key words: rheumatoid arthritis, immunologic diagnostics, autoantibodies, rheumatoid factor, anti-citrulline antibod-ies, antinuclear factor, biomarkers, RA33. </p></li><li><p>21</p><p>- 2012; 54(5): 2024</p><p> - , - - [13]. , . - , - , - [46]. - - , - , [79].</p><p> , , , 6080%[1012]. () - () - , -- ( -, ), , Ro/SS-A- ( 52 ) RA33- [9, 13, 14]. , - - . RA33(ARA33), [15].</p><p> - -, - () RA33, - - .</p><p> , -</p><p> - 253 - , - / (ACR/EULAR) 2010 . [16].</p><p> 37 (17%) 177 (83%) -. 6,27,5 4 39 . .</p><p> - - , - , 120 - 1 12 ( 7,23,6 ), , . 133 - 1 ( 9,27,8 ). </p><p> 82 : 32 (),12 (), 8 - (), 8 , 12 </p><p> (), 10 (). , (n=10).</p><p> IgM IgA, , , (),ARA33 () . (Euroimmun AG, -). () - (Euroimmun AG, ), , IgA (Orgentec, ) ARA33 (Human/Imtec, -). 20 , EULAR/ACR 2010 ., 6 - - Point (EuroDiagnostia, ). - . </p><p> IgM - OLYMPUS ().</p><p> 78%, </p><p>77%, 71%, IgA 43%, 43%, RA33 31% 31%. - IgM IgM . . 1. </p><p> (, ,) IgM. IgM - 8, 3 . - ( 7 , ). </p><p> - ARA33 - , . ARA33 : 31%(48 152 ) 28% (11 42) . -, IgM , - ARA33. </p><p> - , </p><p> 1 (%) </p><p> p</p><p>( ) + -</p><p> (5 /) 87 58 </p></li><li><p>22</p><p>- 2012; 54(5): 2024</p><p> . 26 (12%).ARA33 8 (30%). - RA33 - .</p><p> ARA33 41% , (33%; </p></li><li><p>23</p><p>- 2012; 54(5): 2024</p><p> (165 95 ; p=0,06). - (r=0,58; p</p></li><li><p>24</p><p>- 2012; 54(5): 2024</p><p>, 12 RA33 , ROC- RA33, . -. , 40% - - . - - - -. - AUC, 0,764.</p><p> , - , , . - ARA33 - , , . ARA33 41% , . , - ARA33 [19].</p><p> RA33 - , , - . - ARA33 , - - . ARA33</p><p> - .</p><p> , RA33 - . </p><p> - - . - 10 , - . -, - (Point, EuroDiagnostica, ) - (RheumaCheck, Orgentec, ).</p><p> - - - CCPoint 20 . () - , - . - -- CCPoint .</p><p> () - CCPoint, EuroDiagnostica.</p><p>1. .., .., .. . - . 2007;9(6):63542.</p><p>2. .., .., .. . - . - 2010;3:2330.</p><p>3. Cush J.J. Early rheumatoid arthritis is there a window of oppor-tunity? J Rheumatol 2007;80(Suppl.):17.</p><p>4. .., .., .. . - . 2005;77(12):539.</p><p>5. .., A.A.. - : . 2004;11:311.</p><p>6. .., .., .. . - . 2003;5(56):599608.</p><p>7. .., .., .. . - - - . 2009;14(2):3743.</p><p>8. .., .., .. . - - . 2008;80(10):726.</p><p>9. Keen H.I., Brown A.K., Wakefield R.J. et al. MRI and muscu-loskeletal ultrasonography as diagnostic tools in early arthritis.Rheum Dis Clin North Am 2005;31(4):699714.</p><p>10. .., .., .. . -</p><p> . 2004;76;12:648.</p><p>11. .., .., .. . -- - . 2007;9(1):7784.</p><p>12. Emery P., Breedveld F.C., Dougados M. et al. Early referral recom-mendation for newly diagnosed rheumatoid arthritis: evidence baseddevelopment of a clinical guide. Ann Rheum Dis 2002;61(4):2907.</p><p>13. Malakoutikhah M., Gomara M.J., Gomez-Puerta J.A. et al. Theuse of chimeric vimentin citrullinated peptides for the diagnosis ofrheumatoid arthritis. J Med Chem 2011;54(21):748692.</p><p>14. Schneeberger E., Citera G., Heredia M. et al. Clinical significanceof anti-Ro antibodies in rheumatoid arthritis. Clin Rheumatol2008;27(4):5179.</p><p>15. Pincus T., Sokka T. Laboratory tests to assess patients withrheumatoid arthritis: advantages and limitations. Rheum Dis ClinNorth Am 2009;35(4):7314.</p><p>16. Aletaha D., Neogi T., Silman A.J. et al. Rheumatoid arthritis clas-sification criteria: an American College ofRheumatology/European League Against Rheumatism collabora-tive initiative. Ann Rheum Dis 2010;69(9):15808.</p><p>17. Metz C.E. Basic principles of ROC analysis. Semin Nucl Med1978;8(4):28398.</p><p>18. Nell V.P., Machold K.P., Stamm T.A. et al. Autoantibody profilingas early diagnostic and prognostic tool for rheumatoid arthritis.Ann Rheum Dis 2005;64(12):17316.</p><p>19. Nell-Duxneuner V., Machold K., Stamm T. et al. Autoantibodyprofiling in patients with very early rheumatoid arthritis: a follow-up study. Ann Rheum Dis 2010;69(1):16974.</p></li></ul>