| Objectives:Rheumatoid arthritis(RA)is highly heterogeneous.Most patients with RA are characterized by symmetrical inflammatory small and medium-sized arthritis,and some patients have prominent extra-articular manifestations showing the characteristics of connective tissue disease.To evaluate the possible effect of Antinuclear antibodies(ANA)on disease progression in RA patients by analyzing and comparing the clinical features,extra-articular manifestations,laboratory indexes and treatment between ANA positive and ANA negative RA patients.And whether ANA positive or not can be used to identify patients with inflammatory arthritis or extra-articular connective tissue disease,so as to provide a theoretical basis for early clinical detection,early treatment and improvement of prognosis.Methods:Retrospective analysis was performed on 512 RA patients admitted to the rheumatology and Immunology Department of the First Affiliated Hospital of Wannan Medical College from September 2020 to July 2022,and they were divided into three groups according to the test results of antinuclear antibody.That is,116 patients in the ANA high titer(1:1000)positive group,159 patients in the ANA low titer(1:320)positive group,and 237 patients in the ANA negative group.General data,joint manifestations,extra-articular lesions,laboratory examination and treatment were collected,and the collected data were classified and sorted by SPSS statistical software for statistical analysis and processing.Results:1.Among 512 RA patients,116(23%)were ANA high titer positive,101(87%)were female,the average age was(57±12)years,the average age of onset was(50±13)years,and the median disease duration was 5.0(0.6-11.0)years.There were 159(31%)patients with low titer ANA,123(77.4%)of them were female,the average age was(59±12)years,the average age of onset was(53±15)years,and the median course of disease was 3.0(0.4-10.0)years.There were 237 ANA negative patients,accounting for 46%,of which 156(65.8%)were female.The average age was(61 ±12)years,the average age of onset was(55±14)years,and the median course of disease was 3.0(0.5-10.0)years.The differences were statistically significant(χ2=19.561,P<0.001).The average onset age of ANA high titer positive group was significantly earlier than that of ANA low titer positive group and negative group(F=5.551,P<0.05).By H test,RA patients with high ANA titer had longer course of disease,and the difference was statistically significant(Z=23.750,P<0.05).2.The joint performance of the three groups was compared,RA patients with high ANA titer positive were more likely to have temporomandibular joint involvement than the other two groups,the difference was statistically significant(Fisher exact probability method P<0.05).The other three groups,including the joint involved site,the number of joint swelling,the number of joint tenderness,the presence of joint deformation,pain VAS score and DAS28 score,had no statistical significance.3 By comparison analysis of External articular manifestations(EAMs),the incidence of EAMs in RA patients with high ANA titer(1:1000)positive group was significantly higher than that in ANA low titer(1:320)positive group and ANA negative group.The difference was statistically significant(χ2=8.122,P<0.05),the incidence of interstitial lung disease(ILD)in RA patients with high ANA titer was significantly higher than that in the other two groups(χ2=11.178,P<0.05).Mesh shadows,honeycomb shadows and ground glass shadows were mainly displayed on lung HRCT(χ2=9.418,P<0.05).Compared with the other two groups,ANA high titer positive group was more likely to have blood system involvement(χ2=9.739,P<0.05),which was manifested as a higher incidence of peripheral blood leukopenia(χ2=8.026,P<0.05)and chronic anemia(χ2=6.437,P<0.05),and the differences were statistically significant.The incidence of secondary Sjogren’s syndrome(sSS)in RA patients with high ANA titer was significantly increased compared with the other two groups(χ2=33.918,P<0.05).4.The levels and positive rates of rheumatoid factor(RF),plasma globulin and immunoglobulin G(IgG)in ANA high titer positive group were higher than those in the other two groups,and the level of complement C4 was lower than that in low titer positive group and low titer negative group,with statistical significance(P<0.05).5.Spearman method was used to analyze the correlation factors of sSS,ILD and chronic anemia in ANA positive RA patients.The results showed that ANA titer,karyotype,gender,course of disease and complement level were correlated with the incidence of sSS.ANA titer,karyotype and C4 level were correlated with the incidence of RA-ILD.ANA titer,age,ESR,CRP and C4 levels were correlated with the incidence of chronic anemia,with statistical significance(P<0.05).Binary logistic regression analysis showed that whether patients with ANA positive RA had EAMs was correlated with ANA titer,karyotype,age and complement C4 level,and the difference was statistically significant(P<0.05).6.In the comparison of treatment conditions,the utilization rate of hydroxychloroquine sulfate in RA patients with high ANA titer was higher than that in the other two groups(P<0.05).Conclusions:1.The proportion of RA patients with high ANA titer positive was higher in females,and the age of onset was earlier and the course of disease was longer.2.Female,long course of disease,high titer of ANA,leukopenia,hyperglobulinemia,and decreased complement levels are associated with the risk of clinical RA secondary Sjogren’s syndrome.3.High titer positive ANA,non-granular type(karyotype except fine and coarse granular type),advanced age(mean age≥45 years old)and decreased complement C4 levels are associated with the risk of extra-articular manifestations in RA patients with the course of the disease,especially ILD,sSS,and chronic anemia.For treatment,oral corticosteroids(prednisone dose ≤7.5mg/d)combined with hydroxychloroquine sulfate can be given in small doses. |
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