Il laboratorio nella diagnosi differenziale fra artrite reumatoide precoce e poliartropatia correlata a infezione cronica da virus dell’epatite C

AUTORI

ABSTRACT

The laboratory in the differential diagnosis between early rheumatoid arthritis and polyarthropathy related to chronic infection with hepatitis C virus

Articular involvement is a frequent extrahepatic manifestation of hepatitis C virus (HCV) infection. The distinction between HCV-related polyarthropathy and true rheumatoid arthritis (RA) may be very difficult, especially in patients with recent onset RA before articular damage and erosions develop. The aim of this study was to assess the diagnostic utility of anti-cyclic citrullinated peptide (CCP) antibodies, in comparison with isotype rheumatoid factor (RF), in distinguishing between RA (early and long-standing) and HCV-related polyarthropathy. Anti-CCP and RF IgM and IgA were evaluated in sera of 185 patients with long-standing RA, 100 patients with early RA and 126 patients with HCV infection, 20 of which with related arthropathy. Anti-CCP antibodies were positive in 66.5% and 9.0 % of patients with long-standing AR and early AR, respectively, whereas they were positive in 3.9% of patients with HCV infection. RF IgM were positive in 77.3%, 35.0% and 53.2% of patients with long-standing AR, early AR and HCV infection, respectively. Finally, RF IgA were positive in 62.1%, 25.0% and 7.2% of patients with long-standing AR, early AR and HCV infection, respectively. In the HCV positive population under study, all patients without articular involvement did not show positivity for IgA isotype of RF, while it was positive in 45% of those with arthropathy. In particular, all patients characterized by poliarthropathy showed positivity for IgA isotype of RF. Therefore, the determination of IgA isotype RF can improve the detection of HCV chronic infection patients with associated polyarthropathy.

BIBLIOGRAFIA