Role Of IL-6, Αtnf And Calprotectin In Acpas Positive & Negative Patients Of Rheumatoid Arthritis

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.