الفهرس 
Consequences and socio-economic impactOnly 14 pages are availabe for public view
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Abstract
Introduction: Rheumatoid arthritis (RA) is a systemic autoimmune disease of undetermined aetiology which is marked by chronic inflammation of synovial joints that leads to destruction of cartilage and bone and eventually to disability of the patient. Aim of work: The aim of the present study was to determine anti-citrulline antibodies (Anti-CCP) in the serum of RA patients by ELISA technique and to assess their clinical significance as relation to disease activity and severity. Patients and methods: This study comprised 68 RA patients diagnosed according to the revised criteria described by ACR (1987). They were 64 female patients (94.1%) and 4 male patients (5.9%). In addition, 15 healthy subjects served as control group. Both patient and control groups were age and sex matched. All patients were subjected to: thorough history taking, clinical examination with particular attention to the locomotor system, assessment of RA disease activity and severity (Duke et al., 1983 and Walker et al. 1985) respectively, radiological examination (plain X-ray on both hands evaluated according to Larsen et al., 1977) and laboratory investigations to both studied groups including complete blood picture, ESR, CRP and determination of anti-CCP, IgG-RF, IgM-RF antibodies by ELISA technique. Results: Our results showed that Anti-CCP was found in 65 out of 68 RA patients (95.6%) and not found in the sera of control subjects (0%), while IgG-RF was found in 67 RA patient (98.5%) and in 1 person of the control group (6.7%) and IgM-RF was found in only 59 RA patients (86.8%) and in 1 person of the control group (6.7%). Anti-CCP antibodies showed the highest diagnostic specificity (100 %) than both RF isotypes (93.33 % for each). The anti-CCP and IgG-RF tests had excellent sensitivity (95.59 % and 98.53 % respectively) while IgM-RF had relatively lower sensitivity than both tests (86.76 %). Conclusions: we concluded that anti-CCP antibodies could be regarded as a new diagnostic marker for RA as they have 100% specificity and 95.8% sensitivity. Anti-CCP could predict erosive development early in RA and could be used in evaluating disease activity, severity and therapeutic response than RF isotypes.