Role of Anti-MCV in Arthritis

Role of Anti-MCV in ArthritisIntroductionRheumatoid arthritis (RA) is characterized by joint inflammation resulting in severe deformity, thus, early management is crucial. At a time, rheumatoid factor (RF) was considered the gold standard for diagnosis, however, more specific and sensitive auto-antibodies have been reported. Antibodies against citrullinated peptides, the peptides modified by the conversion of arginine to citrulline, have then been regarded as specific serological markers for RA (Klareskog et al., 2008 Engelmann et al., 2008).Citrullination is a process of protein unfolding, altering protein structure resulting in aberrant recognition in the immune system. They are thought to be triggered by genes that confer susceptibility to RA and by environmental agents (Klareskog et al., 2008).Anti-cyclic citrullinated peptide (anti-CCP) has been proposed as a good alternative to RF for diagnosis of RA owing to its higher specificity and sensitivity (Sauerland et al., 2005). Howe ver, debate exists regarding its specificity in hepatitis C virus (HCV) transmission system (Riccio et al., 2008 Liu et al., 2008).HCV infection is usually asymptomatic and may be detected incidentally it induces immunological extrahepatic manifestations including arthralgia and arthritis which can mirror RA, and discrimination would be difficult without observing the erosions (Palazzi et al., 2008).In addition to anti-CCP, anti-mutated citrullinated vimentin (anti-MCV) has gained importance. Vimentin is a protein filament that is expressed by in the synovium. Modification of this protein occurs in macrophages experiencing apoptosis, thus, anti-vimentin antibodies may emerge if the apoptotic material is not adequately removed (Khalifa et al., 2013).Performance of anti-MCV antibodies has been studied mainly in connective thread diseases (Mutlu et al., 2009 Wagner et al., 2009 Luime et al., 2010), however, no enough data exists regarding its role in discriminating RA from HCV associ ated arthritis.Research QuestionWhat is the role of anti-MCV in differentiating arthritis of rheumatoid origin from that associated with chronic HCV infection?RationaleHCV related arthritis is one of the extrahepatic immunological manifestations of HCV infection and may resemble rheumatoid arthritis (RA). Thus, differentiating patients with HCV associated arthropathy from patients with RA represents diagnostic and therapeutic challenges.HypothesisThe potential role of anti-MCV in discriminating rheumatoid arthritis from HCV associated arthropathy exit be assessed in this study.Aim of the WorkThe aim of this study is to investigate the diagnostic value of anti-MCV in differentiating rheumatoid arthritis (RA) from HCV associated arthropathy.ObjectivesTo total the level of anti-MCV in rheumatoid patients and chronic HCV patients.To assess the diagnostic performance of anti-MCV in differentiating arthritis of rheumatoid disease and chronic HCV infection.Subjects, Material, and Methods Ethics statement every procedures will be conducted in accordance with the ethical principles expressed in the Declaration of Helsinki. Written informed consents will be obtained from all patients will be enrolled in the study.Administrative DesignApproval will be obtained from Zagazig University Institutional Review Board (IRB).SubjectsInclusion criteriaThe study will be conducted on 2 groups of patients recruited from Zagazig University Hospitals sort out I will include 30 patients with rheumatoid arthritis (RA) characterized according to the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) new classification criteria for RA (Aletaha et al., 2010), and negative for anti-HCV antibodies. class II will include 30 patients with chronic HCV-associated arthropathy positive for HCV antibody and RNA.Exclusion CriteriaPatients with any of the following criteria will be excludedPositive for HBs-AgOther connective tissue diseasesChronic infection/inflamm ationMalignancyOrgan transplantMaterial and MethodsThe laboratory section of this part of study will be carried out in the Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University.Clinical divisionDemographic data and disease history will be taken from all patients (age, sex, disease duration). Disease bodily function score (DAS 28) will be calculated for RA patients as per Preevo et al. (1995).Laboratory divisionFive ml blood samples will be aseptically collected from twain groups. Centrifugation will be done followed by storage at -20C until analysis.All samples will be investigated for anti-MCV and anti-CCP using indirect enzyme linked immunosorbent technique (ELISA). All gathered data will be then statistically analyzed using the appropriate statistical tests.