The Significance Of Serum Cartilage Oligomeric Matrix Protein In Patients With Rheumatoid Arthritis

Obsjective:Rheumatoid arthritis is a kind of teratogenic,systemic, chronic,inflammatory autoimmune disease.Research shows that the most significant characteristic is proliferative and inflammatory synovitis of the peripheral joints,which accompanied by progressive and irreversible damage of articular cartilage and bone. Looks from the organization form, the destruction of articular cartilage of RA begins from the symphyses of the cartilage and synovium,the synovial cells here thickening,vasa sanguinea and cell component increases significantly,then form vascular wing and invade cartilage to construct vascular wing /cartilage combination,the result is cartilage and joints destruction,joints deformities and dysfunction. According to the reports in the literature, RA onset of 2 years, could appear irreversible and substantive destruction of the joints,causing one of the main reasons of our country crowd for the disabled labor. Currently the diagnosis and staging of RA patients mainly accords to the clinical symptoms, signs, imaging results and some traditional laboratory tests. Although higher accuracy and sensitivity to diagnose in the middle-late disease diagnosis, these methods often lag behind the development of disease, hard to make a definite diagnosis or discrimination early in the disease. If we can make early diagnosis in biochemical metabolism before morphologic changes and irreversible lesions, we can prevent deformation and disability of the joints,meanwhile evaluate the prognosis of RA bony destruction.Serum cartilage oligomeric matrix protein is a newly discovered metabolic marker of the cartilage.It is a sensitivity serological marker which can reflect bone and cartilage damage. Earliest in 1992, professor Heine-gard of the LUND university in Sweden described it first of all.COMP belongs to the family of thrombosis protein, which is one of the extracellular matrix protein. COMP was discovered from the cartilage tissue initially, in recent years, more and more research shows that COMP expressed in all types of cartilage, eyeball vitreous, muscle button and vascular smooth muscle cells. Although COMP is synthesized by articular cartilage cells, it is not limited to matured cartilage cells only; The COMP was also discovered in the extraction of synovial organization from the patients with rheumatoid arthritis. And in the same condition in vitro cultivation, synovial cells can generate COMP nine times more than the cartilage cells. Compared with other molecular marker, COMP can be more reliably hint joint inflammation, thus we speculate that the synthesis,degradation of COMP and the inflammatory pathology of the synovium changes are closely related.We detectted COMP content in RA patients and healthy people through enzyme-linked immunosorbent assay (ELISA) and anlyzed the relation with pathogenetic condition activities and joints destruction. Looking for early diagnosis and treatment, providing new ideas for prognosis of RA.Methods:(1)Use BCT separately phlebotomize 5 milliliter from healthy adults (i.e. normal control group,20 cases) and RA patients (RA group,60 cases),30 cases of 60 RA patients are in activity, the others are in catabasis. Set serum ex vivo in room temperature for 2 hours,then centrifuged for 20 minutes with 1000r/min,then took upper serum sub-dividing in Eppendorf tube of the 1.5 milliliter.Put the specimens in the -70 degrees Celsius temperature refrigerator.(2)Detected serum COMP and antibodies against cyclic citrullinated peptide (anti-CCP antibodies) with ELISA. Strictly according to the instructions.(3)Recorded the patients' age, duration, morning stiffness of time, joint tenderness index, joint swelling index, joint activity pain index, joint resting pain index, erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), blood platelets (PLT), rheumatoid factor (RF) and hands in each stage of X- ray.(4)All the data measured by statistical software SPSS13.0.Measurement data was represented with mean±standard deviation ( x±S) and the comparision between the two groups was represented with two independent sample t-test.The respective relationship between COMP and age, duration of disease, morning stiffness of time, ESR, anti-CCP antibodies and CRP was represented by Pearson correlation analysis.The significance of inspection difference was represented by P value, P<0.05 showed significant difference and statistical significance.Results:1 The general condition and each laboratory index of RA group: in the 60 cases RA patients, the serum COMP level of 10 male cases is (26.00±9.35) ng/ml, the serum COMP level of 50 women cases is (28.63±8.79) ng/ml, the age of RA patients is (49.62±10.43)years, the course of disease of RA patients is (4.31±6.11)years, the morning stiffness of time of RA patients is (1.84±1.95) hours, the joint tenderness index of RA patients is (15.43±24.49), the joint swelling index of RA patients is (14.18±17.19),the joint activity pain index of RA patients is(19.25±25.24), the joint resting pain index of RA patients is (3.55±10.40),the serum COMP level of RA patients is (28.19±8.86) ng/ml, the RF of RA patients is (433.66±659.76) IU/ml, the ESR of RA patients is (46.62±31.36) mm / 1h, the CRP of RA patients is (4.47±6.55) mg/dl,the PLT of RA patients is (364.47±131.95)* 109 / L, the anti-CCP antibodies of RA patients is (123.40±94.48) RU/ml.2 Comparison of serum COMP level between 60 cases RA patients and 20 normal control : the serum COMP level of RA group is (28.19±8.86)ng/ml and the serum COMP level of normal control is (23.42±5.34)ng/ml, the difference between the two groups is statistically significant (P=0. 006).It shows that the serum COMP level of RA group is significantly higher than the normal control group.3 The comparison of serum COMP level between 30 cases RA patients in activity and 30 cases RA patients in catabasis: the serum COMP level of RA patients in activity is (31.86±8.61)ng/ml, the serum COMP level of RA patients in catabsis is (24.51±7.59)ng/ml, the difference of comparison between the two groups is statistically significant (P = 0.001).It shows that the serum COMP level of RA patients in activity is significantly higher than the RA patients in catabasis.4 The comparison of the serum COMP level between RA patients of 10 male cases and 50 female cases: the serum COMP level of RA patients of 10 male cases is (26.00±9.35)ng/ml, the serum COMP level of 50 female cases is (28.63±8.79)ng/ml, the comparison between the two groups is not statistically significant (P=0.429).It shows that the serum COMP level of RA patients between the male and the female is without significant difference.5 The comparision of the serum COMP level between 30 cases RA patients in catabasis and 20 cases normal control:the serum COMP level of RA patients in catabasis is (24.51±7.59)ng/ml and serum COMP level of normal control is (23.42±5.34)ng/ml, there is no statistically significant between the two groups (P=0.578).It shows that the serum COMP level between the two groups is without significant difference.6 The serum COMP level of 33 cases RA patients with bony damage (hands X-ray staging period achievesⅡperiod or aboveⅡperiod) is (31.05±8.94) ng/ml,the serum COMP level of 27 cases RA patients without bony damage (hands X-ray staging achieveⅠperiod) is (24.68±7.53) ng/ml.The difference between the two groups is statistically significant (P=0.005),the serum COMP level of RA patients with joint bony damage is significantly higher than the serum COMP level without joint bony damage.7 The serum COMP level of RA patients is positively correlated with joint tenderness index, joint swelling index, joint activity pain index, joint resting pain index, morning stiffness of time,ESR,CRP and PLT (P<0.05), and without significant relationship (P>0.05) with the age, course of disease, anti-CCP antibody and RF of RA patients.Conclusion:(1)The COMP level increase in serum of RA patients. (2)The serum COMP level is positively correlated with RA activity. RA patients with high level of serum COMP hint to RA disease activity. (3)The high level of serum COMP is related to bony destruction of RA patients.COMP can be as a serologic index which reflects bony destruction.