title: Unique correlation between mutated citrullinated vimentine IgG autoantibodies and markers of systemic inflammation in rheumatoid arthritis patients.
abstract: Rheumatoid arthritis (RA) is the most common inflammatory systemic autoimmune disease, primarily affecting the peripheral joints. Anti-mutated citrullinated vimentin autoantibodies (anti-MCV) of IgG isotype were shown to be a useful diagnostic marker of RA especially in RA patients who were anti-cyclic citrullinated protein autoantibodies (anti-CCP) negative. Nevertheless, published data correlates rheumatoid factor (RF), anti-CCP or anti-MCV antibodies with either erythrocyte sedimentation rate (ESR) or serum C-reactive protein (CRP) as markers of disease activity, not investigated the possible correlations of RA autoantibodies towards ESR and CRP in comparison. Herein, we aim to evaluate the usefulness of anti-MCV as a dependable marker in established RA compared with anti-CCP and RF antibodies and to examine correlations between RF, anti-CCP and anti-MCV antibodies towards ESR and serum CRP. Serum RF-IgA, RF-IgM, anti-CCP and anti-MCV levels were measured in 30 patients with RA and 40 patients with other autoimmune diseases (non-RA) compared with 20 normal subjects. Specificity, sensitivity and AUC for RF antibodies, anti-CCP and anti-MCV were calculated towards RA diagnosis. Our results showed that ESR and CRP had significantly higher values in both RA and non-RA patients compared with our healthy controls with observed significant increment in RA patients compared with non-RA patients. An important finding from our study is that 33.3 % of RA patients were anti-CCP negative but being positive towards anti-MCV. Also, in-between 36.7 up to 40 % of RA patients were RF-IgA and RF-IgM negative while being anti-MCV positive. Anti-MCV antibodies showed the highest specificity and sensitivity (97.5 and 86.6 %, respectively) towards RA diagnosis with the highest AUC value (0.920) compared with anti-CCP and RF antibodies. Correlation analyses revealed that there was no significant correlation between ESR along with CRP towards RF-IgA, RF-IgM and anti-CCP while profound highly significant correlation exhibited between ESR and CRP towards anti-MCV data (r = 0.879 and 0.994, respectively). Thus, our data suggest that the assessment of serum anti-MCV autoantibodies along with ESR and CRP considered as a simple laboratory regime for monitoring RA patients to assess and follow-up disease activity. The addition of anti-MCV autoantibodies to serologic markers in the ACR/EULAR classification criteria for RA will add points for patients with negative anti-CCP and RF antibodies.
authors.affiliation: Department of Biochemistry, Faculty of Science, Ain Shams University, Cairo, Egypt.
authors.forename: Walid E
authors.initials: WE
authors.lastname: Zahran
authors.affiliation: Department of Biochemistry, Faculty of Science, Ain Shams University, Cairo, Egypt.
authors.forename: Magda I
authors.initials: MI
authors.lastname: Mahmoud
authors.affiliation: Department of Biochemistry, Faculty of Science, Ain Shams University, Cairo, Egypt.
authors.forename: Kamal A
authors.initials: KA
authors.lastname: Shalaby
authors.affiliation: Rheumatology Unit, Ain Shams University Hospital, Cairo, Egypt.
authors.forename: Manal H
authors.initials: MH
authors.lastname: Abbas
keywords: Anti-mutated citrullinated vimentine antibodies; C-reactive protein; Erythrocyte sedimentation rate; Rheumatoid arthritis; Sensitivity; Specificity