| Rheumatoid Arthritis （RA） is a kind of antoimmunity disease, which isdriven by antigen and mediated by T-cell. The characterizations of RA aredamage of symmetrical multi-joints and chronic inflammation out of the joints,which can lead to the disability. There are no exact reasons and mechanism forexplaining the causing such disease in clinic. Thus it is important to explore amethod for diagnosing the RA in clinic. By now， people all of the world havereached a consensus on the treatment of rheumatoid arthritis. Once the diagnosiswas established, the effective disease modifying anti-rheumatic drugs （DMARDs）should be given to control the progress of the disease and reduce the bonedestruction as earlier as possible, which is particularly important to improve theprognosis of disease. Early diagnosis is the basis of early treatment. However，thecurrent diagnostic criteria is based on American College of Rheumatology（ACR）which was revised in1987. It mainly relies on clinical manifestations, X-rayexamination, and serum rheumatoid factor（RF） detection. When meeting theimaging criterion， patients’ bone had been destroyed and eroded. The sensitivityand specificity of RF detection are poor, too. The positive rates of RF aredetected in other autoimmune diseases such as systemic lupus erythematosus（SLE） and even in the older healthy people. It leads to many early patients in thewindow period lose the optimal time to receive timely diagnosis and accept medical treatment. It also improves the rate of disability. Based on the aboveshortcomings, the criteria is not conducive to the early diagnosis of RA. Solooking for simple and easy laboratory testing methods to improve the sensitivityor specificity for the early diagnosis in RA become a hot research area in recentyears.Pepidylarginine deiminases （PADs/PADIs） are enzymes catalyzed arginineresidues in protein chain to citrulline residues.Citrulline is a kind of non-standardamino acids in human. It can’t be produced by the process of protein translation.The citrulline changing process is a kind of protein post-translational modificationprocesses with the help of PADI. So citrulline and the formation of anti-cycliccitrullinated peptide antibodies may play an important role in the pathogenesis andpathology process of RA. Currently, in the known five different types of PADIs,PADI4is the only one existed in the nucleus. It may have a special biologicalfunction. The study found that PADI4could be a pathogenic antigen in RA andplay a significant role in the pathogenesis and pathological process. Also theanti-pepidylarginine deiminase antibodies were detected from the RA patients inrecent research. Consequently， the detection of serological expression level ofanti-peptidylarginine deiminase Ⅳ antibodies in RA patients may have a greatdiagnosis value. It will benefit the diagnosis on the condition that the patients’clinical indexes of RF, AKA, anti-CCP antibodies are negative.Based on others studies, we used the enzyme linked immunosorbent assay（ELISA） to detect anti-PADI Ⅳantibodies levels, analyzing the correlation withthe clinical and laboratory indexes, exploring the diagnosis and application valuein rheumatoid arthritis.During our experiment, we respectively contrasted the serological expressionlevel of anti-peptidylarginine deiminase Ⅳantibodies in96rheumatoid arthritis （RA） patients group,170other rheumatic diseases group and45healthy controlsgroup, analyzing the difference of these three groups and comparing thecorrelation with the other clinical indexes. Then the RA group was divided into theantibodies positive and the negative group. We compared the statisticalsignificance of the clinical information between them. Then the clinical value ofthe combination detection of anti-PADI Ⅳ antibodies, anti-CCP antibodies, RFand AKA were contrasted.The results showed：①The median density of the antibody PADI Ⅳin serumwas10.91（9.61,16.03）U·L-1in RA group,10.36（9.46,11.34）U·L-1in otherrheumatic diseases group and8.93（8.35,10.89）U·L-1in the healthy controls group.The positive rate in these three groups was respectively42.7%,18.8%,15.6%. Thestatistical significances were founded among the three groups （P<0.05）. Comparedthe RA patients with other rheumatic patients, both the median level and thepositive rate level of serum anti-PADI Ⅳantibodies in the former weresignificantly increased, and there were statistical significance between these twogroups（P＜0.05）. The median level and the positive rate in RA group were higherthan the healthy one, there were statistical significance （P＜0.05）, too. However,compared the healthy controls group with RA and other rheumatic patients, both ofthem had no statistical significance（P＞0.05）.②It was also founded that CRP,ESR, IgG, IgA, IgM, C3, C4, DAS28, the incidence of interstitial lung disease, theincidence of X-ray ⅢⅣ phase change from the anti-PADI Ⅳantibody positivegroup in RA patients were significantly higher than the negative one （P＜0.05）.③The medial serum level of anti-PADI Ⅳ antibodies was respectively14.36U·L-1,10.34U·L-1in the high activity group and the non （low） activity group. There wasa significant statistical value （P＜0.05）.④The correlation analysis showedsignificantly positive relativity between anti-CCP antibodies, RF, AKA and the anti-PADI Ⅳ antibodies in the serum of RA group （P were0.033,0.028and0.028,were＜0.05）.⑤The positive rate of the serum anti-PADI4antibodies in RA groupwas respectively27%in RF negative patients,25%in anti-CCP antibodiesnegative patients and31%in AKA negative patients. The positive rate was42%（5/12）when RF and ant-CCP antibodies were both negative，the positive ratewas36%（5/14）when RF and AKA were both negative，the positive rate was47%（9/19）when RF and ant-CCP antibodies were both negative. On the condition ofall the above three factors were negative cases, the positive rate of the serumanti-PADI Ⅳ antibodies was42%（5/12）.We draw these conclusions from our experimental results：①Both the medialserum level of anti-PADI Ⅳ antibodies and the positive gate in RA group arehigher than other rheumatic diseases group and healthy controls group, theanti-PADI Ⅳantibodies maybe a new serological index with great diagnosticvalue to RA patients.②There was a positive correlation between the anti-PADIⅣ antibodies and ESR,CRP, DAS28， the antibody level may be a reference indexthat would forecast the illness activity.③Anti-PADI Ⅳantibodies positivepatients were subject to interstitial lung disease and bone erosion than the negativeones, the level can be used as a severity of the disease process index.④There wasa significant correlation between the anti-PADI Ⅳ antibodies and anti-CCPantibodies, RF, AKA in the serum of RA group， it was helpful to those patientswhose RF，AKA or anti-CCP antibodies were negative. The combined detection ofthem may increase the value of the diagnosis to RA patients. |
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