الفهرس 
Introduction
Rheumatoid ArthritisOnly 14 pages are availabe for public view
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Abstract
This study was conducted on fifty Rheumatoid arthritis patients, seven SLE patients, eight OA patients and fourteen apparently healthy controls. The patients were selected from Rheumatology department and outpatient rheumatology clinic Assiut university hospital. Formal consent was obtained from patients. The study was approved by Ethical committee of faculty of medicine Assiut University.
Studied participants were classified into:
• group 1: 50 RA patients sub classified into:
20 patients with early RA.
30 patients with established RA
The RA patients were diagnosed using the ACR/EULAR diagnostic criteria (2010) (Neogi et al., 2010).
Exclusion criteria: Any patient on biological therapy (TNF inhibitors).
• group 2: Non -RA arthritis (disease control group) include:
15 patients (8 patients with OA and 7 patients with SLE).
Diagnosis of disease controls were confirmed by the attending physician.
group 3: healthy control group Include 14 apparently healthy subjects. The following investigations were done for all subjects:
I-Medical history and full clinical examination.
II-Routine laboratory investigations:
• Complete blood count.
• Chemical investigations: random blood glucose, serum urea, creatinine and liver function tests.
• Immunological tests:
o ESR
o CRP
o RF
III- X-ray: hands and feets (RA patients only).
IV-Special Investigations:
• Serum 14-3-3η protein level determination.
• Serum ACPA level determination.
The current study showed the following findings:
• RF and ACPA showed highly significant increase in RA patients compared to healthy and non-RA arthritis disease control groups while 14-3-3η protein showed highly significant increase in RA patients compared to healthy control group only. There was no significant difference between early and established RA subgroups as regard the studied immunological markers.
• In both early and established RA patients 14-3-3η showed the highest rate of positivity (100%) compared to RF and ACPA positivity enhanced the detection rate of early and established RA over both RF and ACPA by 25% and 33.3% respectively. Adding 14-3-3η to either RF or ACPA or when combining the three markers together resulted in an identification rate of 100% in both early and established RA patients.
• Correlation study showed:
o There were significant positive correlations between RF and ACPA in both early and established RA. Correlation analysis demonstrated no associations of 14-3-3η with the studied clinical and laboratory variables.
• The diagnostic performance of 14-3-3η was better than ACPA and RF in distinguishing RA patient from healthy control group. 14-3-3η protein, at best cutoff value > 2.5 ng/mL, showed the best diagnostic accuracy (95.3%) and AUC (0.916), compared with both ACPA at best cutoff value > 9AU/ml which showed lower diagnostic accuracy (67.2%) and AUC (0.756) and RF at best cutoff value > 7 IU/ml also showed lower diagnostic accuracy (81.9%) and AUC (0.820).
• Since early detection is one of the key approaches to improving the prognosis of RA patients, the diagnostic performance of 14-3-3η was better than ACPA and RF in distinguishing early RA patient from healthy control group. 14-3-3η protein, at best cutoff value > 2.5 ng/mL, showed the best diagnostic accuracy (91.2%) and AUC (0.909) compared with both ACPA at best cutoff value > 9 AU/ml which showed lower diagnostic accuracy (79.4%) and AUC (0.795) and RF at best cutoff value > 7 IU/ml also showed lower diagnostic accuracy (82.4%), AUC (0.850).
• 14-3-3η complements both ACPA and RF and improving their sensitivity and diagnostic accuracy for RA diagnosis. In RA the combination of ACPA and RF yielded 70% sensitivity, specificity 100% and diagnostic accuracy 76.6%. Adding 14-3-3η to either RF or ACPA or when combining the three markers yielded 100% sensitivity, specificity 78.57% and diagnostic accuracy 95.3%. In early RA the combination of ACPA and RF yielded 75% sensitivity, specificity 100% and diagnostic accuracy 85.3%. Adding 14-3-3η to either RF or ACPA or when combining the three markers yielded 100% sensitivity, specificity 78.57% and diagnostic accuracy 91.2%.
Conclusion
from this study, we conclude:
• Serum 14-3-3η protein showed highly significant elevation in RA group compared to healthy control group. There was no significant difference in 14-3-3η protein levels between early and established RA.
• Serum 14-3-3η protein was positive in 100% of early and established RA patients who were seronegative for RF and ACPA. So, it could improve the sensitivity of RA diagnosis and cover the shortage of detection of RF and ACPA in RA patients.
• 14-3-3η is a new complementary marker that improves the diagnostic sensitivity of both RF and ACPA and increasing their diagnostic accuracy. Also, 14-3-3η has a clinical utilization further than RF and ACPA in identifying those patients who require an early referral to a rheumatologist allows earlier detection and treatment in the course of disease, which can minimize irreversible joint damage.