类风湿关节炎活动期滑液中葡萄糖6-磷酸异构酶水平及与抗环瓜氨酸肽抗体的关系

目的 检测葡萄糖-6-磷酸异构酶(GPI)在类风湿关节炎(RA)活动期膝关节滑液中的含量,并探讨滑液中GPI与抗环瓜氨酸肽(CCP)抗体的关系.方法 用酶联免疫吸附法(ELISA)检测22例RA活动期患者和37例骨关节炎活动期患者滑液中GPI和抗CCP抗体的浓度.组间比较采用t检验,相关性分析采用Spearman相关分析.结果 RA活动期患者膝关节滑液中的GPI浓度高于骨关节炎活动期患者[(9.6±8.4)和(0.9±1.8)μg/ml],差异有统计学意义(P＜0.01);RA活动期患者与骨关节炎活动期患者滑液的抗CCP抗体浓度分别为(14.61±18.64)和(1.42:±0.09) U/ml,差异有统计学意义(P＜0.01);RA活动期患者膝关节滑液中GPI含量和抗CCP抗体浓度呈正相关(r=0.447,P=0.037).结论 GPI在RA活动期患者滑液中高表达,可能与RA发生发展过程中慢性滑膜炎、骨质破坏有关.GPI与抗CCP抗体呈正相关,两者可作为RA实验室诊断的参考指标.     

(-)-表没食子儿茶素没食子酸酯对类风湿关节炎的免疫调节机制研究

目的 ①研究(-)-表没食子儿茶素没食子酸酯(EGCG)对类风湿关节炎(RA)患者外周血和滑液中T细胞增殖的影响及对RA相关细胞因子的免疫调节作用.②观察EGCG对RA滑膜成纤维细胞(FLS)增殖的影响.方法 ①取RA患者外周血(30份)、滑液(23份)分离单个核细胞,并分设空白对照组,阴性对照组,甲氨蝶呤阳性对照组,EGCG低、中、高剂量组,通过同位素(3H)掺入法,在体外研究EGCG对RA患者外周血及滑液中T细胞增殖的影响;酶联免疫吸附试验(ELISA)法检测EGCG对RA外周血及滑液中肿瘤坏死因子(TNF)-α、干扰素-γ、白细胞介素(IL)-1、IL-6和IL-17A的影响.②取RA患者滑膜组织(8例)进行原代培养,并分设空白对照组,甲氨蝶呤组(阳性对照),EGCG低、中、高剂量组,通过四甲基偶氮唑蓝(MTT)比色法,在体外研究EGCG对RA患者FLS增殖的影响.统计学处理采用方差分析和SNK-q检验.结果 ①RA患者外周血及滑液中EGCG高剂量组每分钟脉冲数(cpm)值[分别是(15 136±2910),(11587±3135)],较阴性对照组(42 856±2127)(35 748±4512)下降,差异均有统计学意义(P均＜0.01);外周血中ECCG高剂量组TNF-α、干扰素-γ、IL-1、IL-6和IL-17A吸光度值分别是[(321±13)、(298±20)、(132±12)、(197±7)、(59±8)pg/ml],均较阴性对照组[(458±28)、(505±26)、(346±28)、(405±25)、(109±13)pg/ml]下降,差异有统计学意义(P＜0.05或P＜0.01);滑液中EGCG高剂量组TNF-α、干扰素-γ、IL-1、IL-6和IL-17A吸光度值分别是[(41.4±2.9)、(182±16)、(56.3±11.0)、(34.2±1.9)、(44±8)pg/ml],均较阴性对照组[(388.3±19.3)、(469±20)、(104.2±17.8)、(114.5±4.8)、(104±11)pg/ml]下降,差异有统计学意义(P＜0.05或P＜0.01).②EGCG高剂量组FLS吸光度值(0.080±0.017),较空白对照组(0.274±0.041)下降,差异有统计学意义(P＜0.05).结论 EGCG可体外抑制RA患者外周血和滑液中T细胞增殖,抑制TNF-α、干扰素-γ、IL-1、IL-6和IL-17A分泌;可体外抑制RA FLS增殖.     

类风湿关节炎患者血清中期因子和白细胞介素-17的表达

目的 探讨中期因子和白细胞介素(IL)-17在类风湿关节炎(RA)患者血清中的表达及其临床意义。方法 应用双抗体夹心酶联免疫吸附试验( ELISA)法检测79例RA、37例骨关节炎及70名健康体检者血清中中期因子、IL-17,同时应用ELISA法检测血清抗环瓜氨酸肽(CCP)抗体,免疫散射比浊法检测C反应蛋白(CRP)、类风湿因子(RF),间接免疫荧光法检测抗角蛋白抗体(AKA),分析中期因子与IL-17、抗CCP抗体、CRP、RF、红细胞沉降率(ESR)、AKA及RA疾病活动度评分(DAS)之间的相关性。多组间比较采用Kruskal-WallisH检验,2组间比较采用Mann-Whitney U检验,相关分析采用非参数Spearman相关分析。结果 RA组血清中期因子水平(327±167) pg/ml显著高于骨关节炎组(209±130)pg/ml和健康对照组(225±109) pg/ml,差异有统计学意义（H=22.01,P＜0.01）,骨关节炎和健康对照组比较差异无统计学意义(D0.05)。RA组IL-17水平(44±15) pg/ml也显著高于骨关节炎组(26±8) pg/ml和健康对照组( 27±8) pg/ml,差异有统计学意义(H=66.89,P＜0.01),骨关节炎组和健康对照组比较差异无统计学意义（P＞0.05）。血清中期因子水平与IL-17、CRP呈正相关（r=0.398,P＜0.01;r=0.285,P＜0.01）,与DAS、RF、ESR、AKA、抗CCP等无相关性。结论 中期因子和IL-17可能在RA疾病的发生、发展中发挥了一定的作用,通过复杂的细胞因子网络相互协同,促进了RA的发生发展。     

血清淀粉样蛋白A在类风湿关节炎患者体内表达的研究

目的 通过检测血清淀粉样蛋白A(SAA)在类风湿关节炎(RA)患者血清、关节液及滑膜中的表达,探讨其在RA发病机制中的作用.方法 采用酶联免疫吸附试验(ELISA)分别检测RA、骨关节炎患者和健康对照人群血清以及RA与骨关节炎患者关节液中SAA的水平;蛋白印迹法测定SAA在血清中的表达;免疫组织化学技术检测RA和骨关节炎滑膜中SAA的表达.应用t检验或Kruska-Wallis秩和检验进行统计分析.结果 RA血清中SAA含量[(318±132) μg/L]显著高于骨关节炎[(127±47) μg/L]和健康对照组[(127±41) μg/L,P均＜0.01].RA关节液中SAA含量[(571±473) μg/L]显著高于骨关节炎[(129±33) μg/L,t=2.46,P=0.04].蛋白印迹法结果显示各组血清样品中均有SAA条带;RA的SAA表达明显高于其他2组.病理结果显示SAA在RA关节滑膜高表达,位于血管内皮细胞、滑膜成纤维细胞、巨噬细胞以及血管周围;在骨关节炎,SAA仅见于关节血管周围和成纤维细胞.结论 RA血清和关节液中SAA的含量显著增高;SAA在RA滑膜组织中高表达,且表达位置与骨关节炎有明显差别,提示SAA可能参与了RA的炎症反应和关节损害.     

凝集素样受体巨噬细胞诱导性C型凝集素样受体在类风湿关节炎患者巨噬/树突状细胞中表达及其临床意义

目的 研究巨噬细胞诱导性C型凝集素样受体(MINCLE)在健康者、类风湿关节炎(RA)和骨关节炎患者外周血及关节滑液中的表达特征,探讨其与RA发病的相关性.方法 ①采用实时定量聚合酶链反应(PCR)方法在mRNA水平检测RA患者(253例)及健康人(71名)外周血单个核细胞(PBMC)中MINCLE的表达;②采用流式细胞术在蛋白水平检测RA患者(18例)、骨关节炎患者(5例)及健康人(12名)外周血及关节滑液巨噬细胞、髓样树突状细胞(mDC)和浆细胞样树突状细胞(pDC)中MINCLE的表达;采用Mann-Whitney U检验或配对t检验统计分析MINCLE在健康者、骨关节炎患者和RA患者外周血及关节滑液之间的表达差异.结果 ①在mRNA水平,外周血PBMC中RA患者的MINCLE表达达高于健康对照组[(1.65±0.36)和(0.37±0.06),U=6057,P=2.75×10-5];②在蛋白水平,健康人及骨关节炎患者外周血巨噬细胞、mDC及pDC中未见MINCLE的表达;在骨关节炎关节滑液中,MINCLE仅低水平表达于mDC[(7.5±2.9)%]中,而MINCLE在RA患者关节滑液mDC中呈高表达[(34.8±4.4)%,U=0,P=2.6×10-3];MINCLE在RA患者的滑液巨噬细胞及mDC的表达均明显高于其在相对应的外周血中的水平[巨噬细胞(2.01±0.53)%和(0.27±0.51)%,t=4.879.P=2.23×10-6;mDC为(34.8±4.4)%和(21.7±5.5)%,t=2.535,P=0.017].结论 MINCLE的表达特征具有RA组织特异性,MINCLE很可能为RA发病的一个重要标记物.

Abstract：

Objective To determine the expression pattern of macrophage-inducible c-type lectin (MINCLE)on Macrophage(Mφ),myeloid dendritic cell (mDC)and plasmacytoid DC(pDC)in peripheral blood (PB)and synovial fluid(SF)in patients with rheumatoid arthritis (RA).Methods For mRNA expression of MINCLE,253 RA patients and 71 healthy control subjects were enrolled.The mRNA level of MINCLE was determined by real-time PCR.For protein expression of MINCLE,18 patients with RA,5 patients with osteoarthritis(OA)and 12 healthy control subjects were enrolled.The expression of MINCLE on Mφ,mDC and pDC were detected by flow cytometry.The differences of MINCLE expressions in PB between RA patients,OA patients and healthy controls,or differences between PB and SF in RA patients were analyzed using Mann-Whitney U test or paired-samples t test.Results ①Compared to the healthy controls,RA patients showed elevated mRNA expression level of MINCLE in PBMCs[(1.65±0.36)vs (0.37±0.06),U=6057,P=2.75×10-5].②At protein level,MINCLE was hardly detected in Mφ,mDC and pDC in PB of OA patients and healthy controls.In SF,MINCLE was highiy expressed on mDC in RA patients,compared with that in OA patients[(34.8±4.4)%,U=0,P=2.6×10-3].In RA patients,the expression level of MINCLE was remarkably elevated in Mφ,mDC and pDC in SF compared with that in PB[Mφ(2.01±0.53)%vs(0.273±0.51)%,t=4.879,P=2.23×10-6;mDC(34.8±4.4)%vs(22.7±5.5)%t=2.535.P=0.017].Conclusion MINCLE is selectively expressed on Mφ.mDC and pDC in SF in RA patients.MINCLE may serve as a potential important marker,or even target,for RA and possibly even for inflammation in general.     

血清IL-6与TNF-α在克罗恩病疾病评估中的应用

目的探讨克罗恩病(Crohn’s disease,CD)患者血清白介素6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factorα,TNF-α)水平与克罗恩病疾病活动指数(Crohn’s disease activity index,CDAI)之间的相关性,及以上指标判断疾病活动度或黏膜是否愈合的价值。方法回顾性分析2017年4月至2018年3月北京协和医院收治的CD患者51例,并对患者的临床资料进行分析。结果Pearson相关性分析显示,血清IL-6与CDAI呈正相关(r=0.458,P=0.001)。当设定血清IL-6临界值为7.50 pg/ml(≥7.50 pg/ml),判断疾病活动期的ROC曲线下面积(areas under the ROC curve,AUC)(95%CI)为0.851(0.744~0.985),灵敏性及特异性分别为0.800、0.857(P<0.01)。46例未暴露于英夫利西的CD患者行Pearson相关性分析显示,血清TNF-α与CDAI呈负相关(r=-0.352,P=0.016),血清TNF-α水平在黏膜愈合组显著高于黏膜未愈合组[(68.78±60.10)pg/ml vs(34.66±30.03)pg/ml,P=0.039]。结论CD患者血清IL-6水平与经典炎症指标及疾病活动度呈正相关,是判断CD疾病活动度的良好指标。血清TNF-α水平与疾病活动度呈较弱的负相关。     

免疫细胞因子在2型糖尿病周围神经病变大鼠血清中的表达

目的观察免疫细胞因子在糖尿病周围神经病变(DPN)模型大鼠血清中的表达。方法实验大鼠分为正常对照组、糖尿病组和DPN组,每组各12只,腹腔注射STZ制备糖尿病大鼠模型。采用特殊染色及透射电镜法观察各组坐骨神经的组织病理学改变。ELISA法检测各组血清TNF-α、IL-1β及IL-6的表达,并分析其与DPN的相关性。结果组织染色及电镜结果显示,DPN大鼠组织病理学表现符合DPN表现。DPN组TNF-α[(1847.25±289.43)pg/ml]和IL-1β[(171.13±54.98)pg/ml]表达高于糖尿病组[(1430.58±255.56),(143.23±47.05)pg/ml,(P0.05)],而IL-6[(989.45±200.48)pg/ml]表达水平与糖尿病组[(914.23±165.45)pg/ml]比较差异无统计学意义(P0.05)。Pearson相关性分析发现,神经传导速度(NCV)与TNF-α呈直线负相关(r=—0.85,P=0.001)。结论细胞因子TNF-α及IL-1β在DPN大鼠血清中表达升高,且TNF-α是DPN发病的重要危险因素。     

血清TXNIP在非酒精性脂肪性肝病中的临床意义

目的检测非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者血清硫氧还蛋白结合蛋白(thioredoxin-interacting protein,TXNIP)浓度水平,探讨TXNIP在NAFLD中的临床意义。方法用酶联免疫吸附法(ELISA)检测134例NAFLD患者及100名健康对照者血清TXNIP水平,同时收集血糖、血脂等一般资料。结果 NAFLD组血清TXNIP浓度明显高于对照组[(423.94±63.46)pg/ml vs(246.74±83.63)pg/ml,P=0.000];脂肪肝炎组血清TXNIP浓度明显高于单纯性脂肪肝组[(473.30±54.48)pg/ml vs(396.84±65.15)pg/ml,P=0.000]。相关分析表明TXNIP与MDA(r=0.257,P=0.006)、hs-CRP(r=0.178,P=0.018)、TNF-α(r=0.245,P=0.005)、HOMA-IR(r=0.214,P=0.001)呈正相关,但与HDL-c(r=-0.184,P=0.027)、GSH(r=-0.358,P=0.000)呈负相关。多重线性回归分析提示MDA、HOMA-IR是影响TXNIP水平的独立相关因素,血清TXNIP诊断NAFLD和脂肪肝炎ROC曲线下面积为0.957(0.933~0.980)和0.832(0.755~0.909)。结论血清TXNIP与胰岛素抵抗、氧化应激密切相关,有助于NAFLD诊断及病情检测。     

血清趋化素与2型糖尿病患者骨密度水平的相关性研究

目的探讨血清趋化素(Chemerin)水平与T2DM患者骨密度(BMD)及相关因素的关系。方法选取T2DM患者167例,根据WHO骨质疏松诊断标准分为骨量正常组、骨量减少组和骨质疏松组,另选取健康对照(NC)组36名,测量并记录患者临床一般资料及生化指标,检测血清Chemerin、IL-6及TNF-α水平。结果骨质疏松组血清Chemerin[(89.6±12.1)vs(64.7±13.6)ng/ml]、血清炎症因子TNF-α[(15.6±8.6)vs(4.7±3.3)pg/ml]和IL-6[(7.8±3.5)vs(2.2±0.8)pg/ml]水平高于骨量正常组(P0.05)。血清Chemerin水平与病程、HbA1c、BMI、TNF-α呈正相关(r=0.310、0.350、0.760、0.450,P0.05),与腰椎骨密度(BMD L1~4)呈负相关(r=-0.460,P0.05)。多元线性回归分析显示,Chemerin是T2DM患者BMD L1~4的独立影响因素。结论炎症是糖尿病骨质疏松的重要病理生理过程,Chemerin可能通过调控炎症反应参与骨代谢过程,从而促进骨质疏松的发生。     

ICVD患者体内血管活性因子与血脂及抗心磷脂抗体水平的相关性

目的:观察缺血性脑血管病(ICVD)患者血清高敏C反应蛋白(hsCRP)、白介素(IL)-6、肿瘤坏死因子(TNF)-α及肝细胞生长因子(HGF)水平,并分析其与血脂和抗心磷脂抗体(ACA)水平的相关性。方法:回顾性分析2015年3月~2016年8月在我院治疗的45例ICVD患者的临床资料,并选择同期在我院治疗的45例非ICVD患者作为非ICVD对照组。观察比较两组患者血清hsCRP、IL-6、TNF-α、HGF、血脂和ACA水平的差异,分析ICVD患者血清hsCRP、IL-6、TNF-α及HGF水平与血脂和ACA水平的相关性。结果:与非ICVD对照组比较,ICVD组血清hsCRP[(4.69±1.31)mg/L比(8.87±1.56)mg/L]、IL-6[(12.17±4.33)mg/L比(34.26±5.15)mg/L]、TNF-α[(28.45±2.18)pg/ml比(48.35±3.15)pg/ml]、HGF[(502.34±15.36)pg/ml比(876.25±18.15)pg/ml]、ACA[(4.11±0.65)IU/L比(7.89±1.02)IU/L]、总胆固醇[(4.68±1.12)mmol/L比(5.57±1.21)mmol/L]、低密度脂蛋白-胆固醇[(2.62±0.49)mmol/L比(3.24±0.87)mmol/L]和甘油三酯[(1.42±0.31)mmol/L比(1.84±0.37)mmol/L]水平均显著升高,而高密度脂蛋白-胆固醇水平[(1.28±0.25)mmol/L比(1.02±0.22)mmol/L]显著降低,P均=0.001。Pearson相关分析显示,ICVD患者的血清hsCRP、IL-6、TNF-α、HGF水平与血清ACA、TC、LDL-C和TG水平呈显著正相关(r=0.468~0.632,P0.05或0.01),与HDL-C水平呈显著负相关(r=-0.571~-0.511,P0.05或0.01)。结论:ICVD患者血清hsCRP、IL-6、TNF-α及HGF水平显著升高,且与血脂、ACA水平密切相关,可作为临床监测ICVD的重要指标。     

类风湿关节炎患者血清和滑膜骨桥蛋白的测定

目的 研究骨桥蛋白(OPN)在类风湿关节炎(RA)患者外周血中的浓度变化及在滑膜的表达,探讨OPN在RA患者中的发病机制.方法 收集91例RA患者以及29名正常对照人群临床资料和血清,用酶联免疫吸附试验(ELIsA)方法检测OPN在RA患者外周血中的浓度,分析其变化和RA临床及实验室指标的关系.收集7例RA患者和1名正常对照的滑膜组织,用免疫组织化学的方法观察OPN的表达情况.结果 与正常对照组相比,活动组和非活动组的RA患者外周血中OPN水平均明显升高(p＜0.01),且与RA患者的部分临床指标有相关性:与压痛关节数(r=0.435,P=0.005)、关节的X线分期(r=-0.415,P=0.007)、关节功能(r=0.394,P=0.012)显著相关.OPN在RA滑膜组织大量表达,而在正常对照仅见OPN的少量表达.结论 OPN在RA患者外周血中浓度显著升高,且在滑膜表达明显,OPN可能与RA滑膜增生、骨侵蚀有关.     

异基因骨髓间充质干细胞对类风湿关节炎患者主要细胞因子分泌的影响

目的 探讨在体外环境中,异基因骨髓间充质干细胞( Allo-BM-MSCs)对类风湿关节炎(RA)患者的白细胞介素(IL)-1、肿瘤坏死因子(TNF)-α和转化生长因子(TGF)-β1分泌的影响。方法 采集健康供者的骨髓标本,经密度梯度离心分离、纯化获得其骨髓间充质干细胞(bMSCs),进行体外培养扩增。同时采集RA患者的外周血,分离单个核细胞。将来源于健康供者的bMSCs分别与来源于RA患者的单个核细胞和健康供者的单个核细胞在体外进行共培养,用酶联免疫吸附试验( ELISA)法检测bMSCs与淋巴细胞混合培养液中细胞因子IL-1、TNF-α和TGF-β1的变化。采用方差分析和相关性分析进行统计学分析。结果 经bMSCs与RA淋巴细胞共培养7d后,培养液中IL-1浓度(6.2±1.0) ng/L和TNF-α浓度(4.6± 1.2) ng/L低于单独RA组浓度(38.4±0.5)和(29.4±1.3) ng/L,差异均有统计学意义(P＜0.05);但是单独正常淋巴细胞和bMSCs与正常淋巴细胞共培养后,培养液中IL-1浓度(4.4±l.3)和(4.4±1.1) ng/L及TNF-α浓度(5.3±1.7)和(5.0±1.7) ng/L之间比较差异均无统计学意义（P＞0.05）;经bMSCs与RA淋巴细胞共培养7d后,培养液中TGF-β1浓度(22.5±2.2) ng/L高于单独RA组(2.6± 1.0) ng/L,差异有统计学意义(P＜0.05);单独正常淋巴细胞和bMSCs与正常淋巴细胞共培养后,培养液中TGF-β1浓度(4.8±1.4)和(10.5±1.2) ng/L比较差异有统计学意义(P＜0.05)。IL-1与TNF-α呈正相关（r=0.896,P=0.000）,TGF-β1 与TNF-α呈负相关（r=-0.356,P=0.019）,TGF-β1与IL-1呈负相关（r=-0.380,P=0.000）。结论 AlloBM-MSCs在体外可以特异性调节RA患者细胞因子的分泌。bMSCs可能在RA发病和发展中起一定的作用,有希望用于RA治疗。     

Examination of synovial fluid and serum hyaluronidase activity as a joint marker in rheumatoid arthritis and osteoarthritis patients (by zymography)

OBJECTIVE: Hyaluronic acid (HA) is an important joint marker and the substrate for hyaluronidase (HAase). Synovial fluid (SF) and serum HAase were measured to investigate the potential use of HAase as a joint marker in rheumatoid arthritis (RA) and osteoarthritis (OA) patients. METHODS: The subjects were 39 patients with RA and 42 patients with OA. HAase activity was measured by zymography and its relation with various parameters examined statistically. RESULTS: In RA SF a positive correlation (r = 0.458, p = 0.0186) was found between SF HAase activity and the concentration of serum C reactive protein. A positive correlation (r = 0.45, p = 0.024) was also found between SF HAase activity and platelet count in the RA group. Serum HAase activity in the RA group was significantly higher than in the OA group (p < 0.0001) and normal controls (p < 0.0001). CONCLUSION: The results suggest that SF HAase activity could be used as a marker of synovial inflammation.     

男性高血压患者睾酮与动脉顺应性关系的研究

目的 探讨男性高血压患者睾酮与动脉顺应性的关系.方法 按照收缩压≥140 mm Hg(1 mm Hg=0.133 kPa)和(或)舒张压≥90 mm Hg诊断为高血压的标准,将277例受试者分为男性对照组、男性高血压组、女性对照组和女性高血压组.采用CVProfilor DO-2020动脉脉搏分析仪分别测定各组受试者大动脉顺应性(C1)、小动脉顺应性(C2),用酶促化学发光法检测血清睾酮浓度,用放免法检测血清胰岛索浓度.结果 (1)男女性高血压组C1、C2均显著低于相应对照组,血清睾酮浓度在男性高血压组低于男性对照组(P均<0.01),而在女性两组问比较差异无统计学意义.(2)睾酮在男性组与C1、C2正相关,与血压、甘油三酯、血糖、体质指数、胰岛素抵抗指数负相关.在女性组与体质指数负相关(P均<0.05).(3)多元逐步回归分析表明,年龄、睾酮足影响男性血压的主要因素,年龄、C2、体质指数是影响女性血压的主要因素.结论 动脉顺应性减退是高血压的预测指标;中年男性血清睾酮水平下降与动脉顺应性减退密切相关,是男性发生高血压的主要危险因素之一.     

Synovial fluid levels of anti-cyclic citrullinated peptide antibodies and IgA rheumatoid factor in rheumatoid arthritis, psoriatic arthritis, and osteoarthritis

OBJECTIVE: To assess the levels of anti-cyclic citrullinated peptide (anti-CCP) and IgA rheumatoid factor (IgA-RF) in synovial fluids of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and osteoarthritis (OA). METHODS: Knee effusions of 29 patients with RA (23 women, 6 men; mean +/- SD age 60 +/- 15 years), 20 with PsA (6 women, 14 men; mean age 51 +/- 12 years), and 19 with OA (9 women, 10 men; mean age 73 +/- 11.8 years) were aspirated, tested for white blood cell (WBC) counts, centrifuged, and stored at -20 degrees . Sera of 22, 11, and 12 of these patients with RA, PsA, and OA, respectively, were similarly stored. IgG anti-CCP and IgA-RF were detected by enzyme-linked immunosorbent assay. Erythrocyte sedimentation rate and C-reactive protein levels were used as measures of disease activity. RESULTS: Mean levels of synovial fluid anti-CCP and IgA-RF were significantly increased in RA joint effusions compared with PsA and OA (anti-CCP: 150 +/- 134, 34 +/- 29, and 24 +/- 26 units, respectively [P < 0.003]; IgA-RF: 76 +/- 77, 15.7 +/- 10, and 18 +/- 20 units, respectively). No significant difference was noted between OA and PsA. A significant correlation was found between synovial fluid anti-CCP and serum anti-CCP and IgA-RF. In patients with RA, a significant correlation was found between synovial fluid WBC counts and IgA-RF (P = 0.03) and serum IgA-RF (P = 0.008), but not between synovial fluid and serum anti-CCP levels. In RA patients, C-reactive protein correlated with serum IgA-RF. CONCLUSION: Anti-CCP and IgA-RF were significantly increased in synovial fluid of RA in comparison with PsA and OA patients.     

Cartilage Oligomeric Matrix Protein (COMP): Die Rolle eines nichtkollagenen Knorpel-Matrix- Proteins als Marker der Krankheitsaktivität und Gelenkzerstörung bei Patienten mit rheumatoider Arthritis und Arthrose

Today, we can assess criteria to predict the tissue destruction and progression of Rheumatoid Arthritis (RA) and Osteoarthritis (OA) only in a late stage of the disease. It would be an advantage to have biochemical markers of disease activity and joint destruction to optimize therapy. PATIENTS AND METHODS: In this cross-sectional study with 37 RA and 20 OA patients (disease duration 119 +/- 130 months for RA and 41 +/- 73 months for OA), ESR, CRP, disease activity score (DAS), the functional status of RA (American College of Rheumatology), and the radiological scoring systems of Larsen and Kellgren/Lawrence, respectively, were used as parameters for disease activity and joint destruction. Cartilage oligomeric matrix protein (COMP) was measured with an enzyme-linked immunosorbent assay (ELISA) in serum and synovial fluid, COMP fragments with immunoblot in the synovial fluid. RESULTS: The mean COMP value in synovial fluid was 38 ug/ml (RA) and 46 ug/ml (OA); 6.5 ug/ml (RA) and 3.4 ug/ml (OA) in serum. RA patients had a higher amount of small COMP fragments in synovial fluid than OA patients. In RA patients, there was a significant positive correlation between disease activity (DAS) and COMP in synovial fluid and serum, a negative correlation between functional status of RA and serum COMP and between radiologic joint destruction of the knee and serum COMP. In OA patients, there was a significant correlation of joint space width and synovial fluid COMP. DISCUSSION: A high clinical disease activity (DAS) correlated with high COMP values in serum and synovial fluid and with increasing proteolytic activity (higher amount of small COMP fragments especially in RA). An increased turnover of cartilage matrix in joint inflammation might explain this correlation. The correlation of decreased COMP with decreased functional status in RA and increased joint destruction is compatible with a loss of cartilage and less turnover. The correlation between joint space width and increased COMP in OA patients with short disease duration might be explained with a higher turnover of the cartilage matrix in the early stage of the disease.