Abstract:
Auto immune disease such as Rheumatoid Arthritis is the consequence of persistence
imbalance between proinflammatory cytokines and anti-inflammatory immune
mechanisms leading to chronic inflammation. In RA, many factors activate multiple
pathways, all converging to enhance osteoclastogenesis, ultimately disturbing bone
metabolism to bring about joint destruction. This study is aimed at finding levels of serum
calprotectin, serum IL-6 and serum TNF-α in treatment naïve seropositive and seronegative
RA patients. It also aimed at finding association of these parameters with RA disease in
Pakistani population.
Subjects and Methods
A comparative cross-sectional study was carried out at RA patients of age 35-55 years, not
yet started any treatment, divided into group 1 ACPA +ve (n=28) Group 2 ACPA -ve
(n=28) and Group 3 healthy control (n=28). Blood samples were taken and processed for
serum preparation and stored at -80˚C. The anthropometric profile (height, weight and body
mass index) was recorded. ESR, CRP and serological record were taken from medical file
of patient. Calprotectin, IL-6 and TNF-α were estimated by human ELISA kits. Data was
analyzed by SPSS-21. Normality was checked and statistical tests were applied
accordingly. A p value of < 0.05 was considered significant.
Results
Level of Serum calprotectin, IL-6 and TNF-α were significantly elevated in both ACPA
+ve and ACPA -ve RA patients as compared to healthy controls (p value < 0.001), (p value
< 0.001), (p value < 0.001) respectively. However, no significant difference in levels of
calprotectin, IL-6 and TNF-α was noticed in ACPA +ve and ACPA -ve groups (p value <
0.179), (p value < 0.725), (p value < 0.629) respectively. A notable association of these
parameters with DAS-28-ESR was also found. Both seropositive and seronegative groups
of our study reported high DAS -28.
Conclusion
This study found that levels of serum calprotectin, IL-6 and TNF-α were significantly
elevated in RA patients as compared to healthy controls and these high levels were
associated with RA disease activity. These findings suggest their possible role in disease pathology and these parameters show notable association with disease severity. Moreover,
the study concluded that, severity of disease is equally high in both seropositive and
seronegative RA patients. Hence, seronegative RA patients cannot be ignored and should
be treated promptly. Also, the study concluded that calprotectin has discriminatory capacity
to predict disease activity in both groups equally.
