ANTICYCLIC CITRULLINATED PEPTTDE ANTIBODIES: ROLE IN THE DIAGNOSIS OF RHEUMATOID ARTHRITIS AND DIFFERENTIATION FROM PATIENTS WITH CHRONIC HEPATITIS C VIRUS INFECTION WITH ARTICULAR MANIFESTATIONS.
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Objecti^e: The study is undertaken to assess the value of anticyclic citrullinated peptide antibodies (anti-CCP Abs) as specific serological marker for the diagnosis of RA and its relation to disease activity. It is also meant to explore if this marker can be used to distinguish between RA patients and hepatitis C virus (HCV) infected patients with articular manifestations. Methodology: After full history taking and thorough clinical examination, serum samples from 27 RA patients, 39 HCV infected patients and 25 healthy subjects, were tested for IgG RF and anti-CCP antibodies by latex agglutination and commercial second generation anti-CCP enzyme-linked immunosorbant assay (ELISA) respectively. Results: Articular manifestation were present in (40.1%) of HCV patients. There was a highly significant (P<0.001) increase of anti-CCP Abs level in RA patients.than HCV patients and controls. Anti-CCP Abs were detected in 70.3% patients with RA and 2 patients (12.5%) of HCV (with high level 137u/ml) infected patients with articular manifestations but not in any HCV infected patient without articular manifestations. Clinical and radiological evaluation of these two patients verified that, they had typical RA erosions and they developed the full blown-picture of RA. Anti-CCP Abs level in RA patients was increased with higher grades of disease activity (P<0.001). RF was detected in 77.7% patients with RA, 13% HCV infected patients without articular manifestations and 37.5% HCV infected patients with articular manifestations. Although IgO RF had a higher sensitivity for RA (77.7%), it was less specific (90%) versus