الفهرس 
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Abstract
Rheumatoid Arthritis (RA) is a common systemic autoimmune disease with a significant level of morbidity and mortality. Approximately 1% of the world population is affected by the disease. Like many autoimmune diseases, RA occurs more frequently in females than males (30.8 vs 12.7/10,000 respectively). The diagnosis of RA depends primarily on clinical manifestation of the disease. According to the 1987 ACR criteria for diagnosis of RA, the only serological test routinely used is the determination of the presence of RF in the serum. With the availability of DMARDs, it is important to diagnose and treat the disease early to avoid long term damage. Such an approach requires a specific and sensitive serological test to identify RA patients early in the course of the disease. In the second half of the 1990’s, several autoantibodies can be detected in a spectrum of RA. APF, AKA and anti-fillagrin antibody have been shown to be highly specific for RA, but there are no commercial assays available for these tests for a variety of reasons. Anti-CCP antibodies are detected in roughly 50-60% of patients with early RA usually after 3-6 months of symptoms. The specificity of anti-CCP is around 95-98% as regards undifferentiated forms of arthritis that do not develop into RA. IgM RF are often found in the same patients, but with much lower specificity for RA. Anti-CCP antibodies may pre-date arthritis by several years. Anti-CCP has been shown to be an independent predictor of radiological damage and progression. The combination of anti-CCP and IgM RF increased the ability to predict erosive and progressive disease. Regarding its prognostic value in established RA, anti-CCP seropositivity has been associated with a more severe, destructive disease course. The 2010 ACR/EULAR classification criteria for RA focused on identifying the factors among patients newly presenting with undifferentiated inflammatory synovitis. Using these criteria, classification as definite RA was based upon the presence of synovitis in at least one joint. Anti-CCP is one of the laboratory biomarkers of inflammation and autoimmunity used in the 2010 ACR/EULAR classification criteria for RA.