RA patients (n=50) |
Controls(n=30) |
|
Age (years) |
45.35±6.76 |
44.9±5.87 |
Sex (male/female) |
2/48 |
1/29 |
Disease duration (years) |
10.50±43.9 |
----------- |
DAS-28 |
5.83±1.6 |
----------- |
ESR (mm/1st h) |
38.85±18.5* |
11.43±0.26 |
CRP (mg/dl) |
25.22±3.6* |
1.29±0.17 |
RF (IU/ml) |
67.45±12.4* |
5.60± 1.16 |
Anti-CCP(U/ml) |
233.6±67.6* |
15.60±6.05 |
Fibrinogen (g/l) Median |
5.23(1.01–4.15) |
1.45(1.23–1.10) |
Albumin (gm/dl) Median |
4(3.9–3.2) |
3.8(3.6–4.0) |
AFR Median (IQR) |
0.90 (0.84–1.04) |
3(1.9–3.5) |
Table 2: Radiological parameters in rheumatoid arthritis patients (n=50)
Modified larsen score |
32.9 ± 11.2 |
MRI wrist joints scores |
|
Synovitis |
4.4 (1-7) |
Bone erosions |
3.5 (1-13) |
Bone defects |
2.5 (0-7) |
Bone edema |
1.6 (0-11) |
MRI MCP joints scores |
|
Synovitis |
6.9 (2-10) |
Bone erosions |
1.9 (0-10) |
Bone defects |
1.5 (0-6) |
Bone edema |
1.4 (0-19) |
Values are mean (interquartile ranges) JSN, joint space narrowing; MCP, metacarpophalangeal.
Table 3: Correlation between AFR with clinical, laboratory, and radiological data in rheumatoid arthritis patients (n=50).
Parameter |
AFR |
|
R |
P |
|
Age (years) |
0.271 |
NS |
Disease duration (years) |
0.165 |
NS |
DAS-28 |
0.819 |
<0.001* |
ESR (mm/1st hr) |
0.732 |
<0.001* |
CRP (mg/dl) |
0.675 |
<0.001* |
RF (IU/ml) |
0.132 |
NS |
Anti-CCP (U/ml) |
0.241 |
NS |
Modified Larsen score |
0.763 |
<0.001* |
MRI score for synovitis wrist joints |
0.522 |
<0.001* |
MCP joints |
0.763 |
<0.001* |
MRI score for erosion wrist joints |
0.861 |
<0.001* |
MCP joints |
0.632 |
<0.001* |
*Pearson’s correlation coefficient. NS: non-significant, *=significantly different compared to controls. DAS-28, disease activity for 28 joint indices score; ESR, erythrocyte sedimentation rate; CRP, C reactive protein; RF, Rheumatoid factor; anti-CCP: anti-cyclic citrullinated peptide; mSvH: Modified Sharp/Van der Heijde, MRI: Magnetic resonance imaging, MCP: Metacarpophalangeal, AFR, albumin/fibrinogen.
Discussion
Rheumatoid arthritis is a progressive inflammatory musculoskeletal disease that causes systemic affection in addition to severe joint damage. To avoid its severe manifestations, early diagnosis and detection of disease activity is needed. Increased CRP, fibrinogen, and ferritin as acute phase reactants is a prominent feature of autoimmune diseases such as RA which reflects the inflammatory state [14, 15].
Our study revealed a significant increase in serum level of fibrinogen, ESR, and CRP in rheumatoid patients compared with the control group and this is usually occurring in inflammatory disorders [16].
Some previous studies demonstrated that AFR may be used as convenient laboratory markers, which indirectly reflect the state of inflammation and disease activity in some rheumatic diseases such as RA, AS [17].
In our study, there was a significant decrease in serum level of AFR in rheumatoid patients as compared to the control group and significantly negatively correlated with DAS, ESR, CRP and Larsen score and MRI scores, this is in agreement with previously reported by Yang et al who declared that AFR is correlated with DAS and CRP. Also, they could be simple predictors of disease activity in RA patients [17].
In our study, there was no relation between AFR ratio and RF& Anti CCP, and this is in agreement with another study that revealed no relation between ratio and ACPA, but they are significantly correlated to RF titer [18].
In this study, it was found that AFR ratio are correlated with Larsen score and MRI score for synovitis and erosion These data suggest the strong association of fibrinogen and AFR with RA outcome and joint damage and these results are similar to another study [19].
Fibrinogen (FIB) is a key factor implicated in the process of the blood coagulation cascade, and its deposition in the joint was identified to be characteristic of RA and even may be responsible for the formation of pannus tissue [20].
FIB is an important glycoprotein present in human blood plasma and it is involved in many physiological processes such as wound healing, tissue regeneration, and regulation of inflammatory responses [26]. Moreover, FIB has been shown as an important determinant of inflammatory arthritis through its effects on pro-inflammatory pathways such as NF-κB signaling [21]. A recent study showed that circulating levels of FIB are elevated in RA and correlated with markers of inflammation [22] and this is in agreement with our study.
Conclusion:
AFR may be easily, rapidly detected and prognostically useful markers of ongoing inflammation and joint affection correspondingly to radiological findings.
DECLARATIONS
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflicts of Interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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