Background In the early phase of rheumatoid arthritis (RA) the patients do not yet fulfill the criteria for disease1. To meet the need for improved diagnostic tests and algorithms, various serum biomarkers are being assessed for the improved diagnosis of RA. However, only rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) have gained wide acceptance2.
Objectives A multi-biomarker score (MB) are powerful emerging tests that have the potential to answer significant clinical diagnostics problems by integrating multiple proteomic markers3. The aim of this study was to evaluate the performance of a candidate multi-biomarker score in diagnosis of early RA (MBERA).
Methods We studied 102 patients (pts) with early RA (with<6 months disease duration) (23 man, 79 woman, median age 51, 41-62years),27 pts with systemic lupus erythematosus (SLE), 15 pts with Sjogren’s syndrome, 25 pts with ankylosing spondylitis, 24 pts with osteoarthritis, 20 pts with OVERLAP, 9 pts with gout, 22 pts with psoriatic arthritis, 168 pts with undifferentiated arthritis and 297 healthy individuals. 4 antibodies (IgM RF, IgA RF, anti-CCP, AMCV), 3 inflammation markers (ESR, CRP, calprotectin), markers of bone (sRANKL) and cartilage (COMP) metabolism, 27 cytokines (IL-1β,-1ra,-2,-4,-5,-6,-7,-8,-9,-10,-12,-13,-15, -17, basic FGF, eotaxin, G-CSF, GM-CSF, IFN-γ, IP-10, MCP-1, MIP-1α, MIP-1β, PDGF-BB, RANTES, TNF-α, VEGF) serum concentrationswere measured. Analysis of consistency and confidence as biomarkers of early RA was carried out by multivariate logistic regression.
Results The MBERA score was calculated based on the concentrations of 6 biomarkers (anti-CCP, CRP, IL-6, IFN-γ, GM-CSF, IP-10). The MDERA demonstrate a superior performance (AUC 0,98; sensitivity 94%; specificity 81%; LR+ 4,9; LR- 0,1) versus RF (AUC 0,8; sensitivity 67%; specificity 79%; LR+ 3,2; LR- 0,4) and anti-CCP (AUC 0,7; sensitivity 59%; specificity 87%; LR+ 4,5; LR- 0,4) to diagnosis early RA.
Conclusions Diagnostic performance of MBERA is superior versus IgM RF and anti-CCP. After accurate validation, this test could be used in clinical laboratory practice.
A. Willemze, R.E.M. Toes, T.W.J. Huizinga, L.A. Trouw. New biomarkers in rheumatoid arthritis. Neth J Med. 2012 Nov;70(9):392-9.
P. Taylor, J. Gartemann, J. Hsieh, J. Creeden. A Systematic Review of Serum Biomarkers Anti-Cyclic Citrullinated Peptide and Rheumatoid Factor as Tests for Rheumatoid Arthritis. Autoimmune Diseases Volume 2011, Article ID 815038, doi:10.4061/2011/815038.
Disclosure of Interest None Declared