Application Of Combined Detection Of Pyridinoline Cross-linked Carboxy-Terminal Telopeptide Of Type Ⅰ Collagen (ICTP),Synovial Thickness For The Diagnosis And Treatment Of Early Rheumatoid Arthritis

Objective: To evaluate the clinical application of serum pyridinoline crosslinked carboxy-terminal telopeptide of type I collagen(ICTP),anti-cyclic citrullin ated peptide(CCP),rheumatoid factor(RF)and synovial thickness detection to the early diagnosis and disease monitor of rheumatoid arthritis.Method:(1)Selection conforms to the American rheumatism association(A CR) and the European Union fights rheumatism(EULAR) jointly launched 2010 RA diagnosis standard of 130 RA patients, according to the course of the di sease is divided into 90 cases of patients with early RA group [duration less t han 1 year, the pre-hospital unused anti-rheumatism alleviate drugs(DMARDs)], middle-late 40 patients with RA group(duration is more than 2 years). Patie nts with early RA group in rheumatoid arthritis patients assessment rating(DA S28 score), respectively, with DAS28 > 3.2 accurate judgment for disease activ ity, early RA patients can be divided into group of 32 cases of early RA activ ity, stable group of 58 cases.(2)Select other 45 cases(non-RA) patients with rheumatoid immune disea se and healthy donors were 45 cases.(3)For all entrants refers to the line of double and palm and proximal int erphalangeal joint synovial thickness inspection, measuring the thickness in syn ovial the thickest place. For all the men were determined fasting serum ICTP, RF, anti CCP antibody.(4)Early RA group record age, gender, height(mm), weight(Kg), the nat ure of work(physical, mental), morning stiffness duration(h), joint tenderness,swelling, counting, condition assessment(DAS28), health questionnaire(HAQ),pain index(VAS score), and to improve disease resistance rheumatism drugs(DMARDs) [methotrexate(MTX) +leflunomide(LEF)] treatment, joint pain is o bvious to non-steroidal anti-inflammatory drugs(NSAIDs) and(or) small doses of corticosteroids to relieve the pain symptoms, follow-up observation and rec ord, three months before treatment, the 6-month serum anti CCP antibody, ICTP, RF and synovial membrane thickness changes.Results:(1)The serum levels of anti-CCP antibody, RF in early RA patien ts were higher than non-RA patients and normal controls(P<0.05),And in early active RA was higher than early stable RA(P<0.05).The concentration of ICT P was no significant difference between early RA and non-RA(P>0.05),But sig nificant difference was found between early RA, non-RA patients and normal c ontrols(P<0.05).Synovial thickness in early RA was higher than other groups(P<0.05),but early active RA patients did not differ from early stable RA patients(P>0.05).(2)Early RA activity groups with ease in gender, age, height, weight, nat ure of work between compared with no significant difference(P > 0.05). Early RA activity groups with ease in joint tenderness, swelling, counting, morning stiffness duration(h), VAS score, HAQ, DAS28 between significant differences(P < 0.05).(3) ICTP in early RA group and joint tenderness, swelling, VAS score, D AS28 were positively correlated(P < 0.05), and the morning stiffness time(h),HAQ no correlation(P > 0.05); Synovial thickness no correlation with the cli nical indexes(P > 0.05). ICTP, synovial membrane thickness and no correlatio n between CCP antibody and RF(P > 0.05), synovial membrane thickness andICTP no correlation(P > 0.05), anti CCP antibody and RF were positively c orrelated(P < 0.05).(4)The four highest sensitivity detection index of synovial thickness, higher than that of the RF, but specific minimum. Anti CCP have the highest specific degrees, and have higher about index and positive predictive value, the four examination indexes between th e joint detection can significantly promote the early diagnosis of early RA specific degree s: CCP + ICTP specific degree was 98.7%, and the resistance against CCP + RF + ICTP speciality rate was 99.3%, and the resistance to CCP + ICTP + synovial thickness specia lity rate was 99.5%, and the four indicators combined detection sensitivity is 27.4%, 100%, and sensitivity to the early RA diagnosis decreased, but the specific degree increased s ignificantly.(5)Early RA group was given to change a anti-rheumatism drugs(DMARDs) treatment(joint pain obviously can give NSAIDs or small doses of cortico steroids to relieve the pain symptoms), respectively, follow-up and record the t esting index, three months before treatment and the 6-month changes. Anti CC P, RF in the six month and three months compared with before treatment, the six month compared with three months levels were significantly decreased(P < 0.05). ICTP, synovial membrane thickness in the three months there was no evident difference compared with before treatment(P > 0.05), but declined, e arlier in the 6-month compared with three months before, treatment significantl y decreased(P < 0.05).Conclusion: Serum ICTP is a sensitive serum marker to monitor the early damage of arthrosis. Combining anti-CCP antibody and ICTP, RF, Synovial th ickness can increase diagnosis specificity of early RA, reduce missed diagnosis rate of early RA(Especially for highly suspected but diagnosis is not confor m to the criteria for the diagnosis of early RA patients).Dynamic joint detectio n of the above indexes can not only effectively monitor the disease progressio n and bone damage of RA, but also provide clinical basis for grasping the opt imal therapy time and estimating the curative effect.