Differentiation of Rheumatoid Arthritis From HCV Infection: Rheumatoid Factor, Anti-Cyclic Citrullinated Peptide or Anti-Mutated Citrullinated Vimentin?
Ece Kaptanoğlu1, Işılay Nadir2, Zahir Bakıcı3, Emrullah Hayta4, Mehmet Türkmen1, Hafize Sezer5, Sami Hizmetli1, Hasan Elden1
1Cumhuriyet Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Sivas, Turkey
2Numune Devlet Hastanesi, Gastroenteroloji Bölümü, Sivas, Turkey
3Cumuriyet Üniversitesi Tıp Fakültesi, Mikrobiyoloji Anabilim Dalı, Sivas, Turkey
4Numune Devlet Hastanesi, Fizik Tedavi Bölümü, Sivas, Turkey
5Cumhuriyet Üniversitesi Tıp Fakültesi, Biyoistatistik Bölümü, Sivas, Turkey
Keywords: Rheumatoid arthritis, HCV, rheumatoid factor, anti-CCP, anti-MCV
Objective: Differentiation of rheumatoid arthritis (RA) from other diseases with joint involvement such as hepatitis-C virus (HCV) infection represents a diagnostic problem. In addition to the rheumatoid factor (RF), more specific and sensitive auto-antibodies are under evaluation in recent years with conflicting results. In this study, we tested the diagnostic value of rheumatoid factor, anti-cyclic citrullinated peptide (anti-CCP) and anti-mutated citrullinated vimentin (anti-MCV) in distinguishing RA from hepatitis C patients.
Materials and Methods: Sera of 34 RA patients and 30 hepatitis C patients were tested for RF, anti-CCP anti-MCV. Disease activity was determined by disease activity score (DAS-28) 28 in RA and by modified Knodell score in hepatitis C patients. Extra-articular involvement in RA and rheumatologic involvement in hepatitis C patients were documented.
Results: In roc analysis, area under curve (AUC) was the highest in anti-CCP. Sensitivity and specificity was 82% and 53%, 79%, and 96% and 70%, and 73% for RF, anti-CCP and anti-MCV respectively. DAS-28 has a weak correlation with RF (r=0.406), anti-CCP (r=0.433), and anti-MCV (r=0.453). There was no difference between the patients in autoantibody levels regarding extra-articular involvement and DAS-28 in RA, and joint involvement in hepatitis C patients.
Conclusion: Anti-MCV antibodies may be useful in distinguishing RA however it seems to have no additional value over anti-CCP or RF in hepatitis C patients. Anti-CCP antibodies are more reliable in diagnosis of RA due to their high specificity. (Turk J Rheumatol 2010; 25: 19-23)