Antibodies to citrullinated proteins and rheumatoid factor (RF) are widely used in patients with rheumatoid arthritis (RA) and the antibodies to citrullinated proteins appear to be the most specific markers of the disease. The objective was to compare the diagnostic performance of the anti-cyclic citrullinated peptide 2 (anti-CCP2) and citrullinated protein Antibodies (CPA) with RF in the diagnosis of RA. Serum samples of 139 patients with RA and 131 patients with other rheumatic diseases were checked for anti-CCP2, CPA uses citrullinated recombinant rat filaggrin as the antigen assay, and RF. The specificity, sensitivity, and receiver operating characteristic (ROC) of tests were then compared. The sensitivity of anti-CCP2, CPA, and RF were 82.7, 83.5, and 61.5%, respectively. The specificities of the tests were 91.2, 78.6, and 90.5%, respectively. The area under ROC curves for the tests were 0.925, 0.890, and 0.847, respectively. Exclusion of overlaps was associated with improved specificity for CPA but no change in the specificity of RF and anti-CCP. The sensitivity of anti-CCP2, CPA, and RF were 66.7, 77.8, and 51.9% for patients with early RA, respectively. The findings of the present study indicate that anti-CCP2 might be of a better diagnostic value for the diagnosis of RA. They also showed that CPA and in the second place anti-CCP2 were useful in the diagnosis of early RA.

Objective: To evaluate the clinical utility of a novel radiotracer, Tc-glucosamine, in assessing disease activity of both rheumatoid arthritis (RA) and ankylosing spondylitis (AS).Material and Methods: Twenty-five patients with RA (nine males and 16 females) and 12 patients with AS (all male) at various stages of disease were recruited for the study. A clinical history and examination was performed, followed by the measurement of hematological, biochemical, and autoimmune serological parameters to assess disease activity. Tc-glucosamine was intravenously administered and scans were compared with other imaging modalities, including plain X-ray, magnetic resonance imaging (MRI), and bone scans. Results: In patients with AS, 99mTc-glucosamine scans were more capable of identifying active disease and differentiating between inflammatory and non-inflammatory causes. In patients with RA, 99m Tc-glucosamine accumulated at all known sites of disease involvement. Uptake was most pronounced in patients with active untreated disease. The relative tracer activity in the involved joints increased with time compared with that in the adjoining soft tissue, liver, and cardiac blood pool. Using Spearman's correlation coefficient, there was a positive correlation among glucosamine scan scores, C-reactive protein (p=0.048), and clinical assessment (p=0.003), which was not noted with bone scans. Conclusion:The radiotracer was well tolerated by all patients, with no adverse reactions. Tc-labeled methylene diphosphonate nuclear bone scans for imaging inflamed joints and had the added advantage of demonstrating a significant clinical correlation between disease activity and scan findings.Keywords: Glucosamine, rheumatoid arthritis, ankylosing spondylitis, nuclear scan ments of cells at these sites. Tc-glucosamine can be locally produced by a nuclear scientist in a major nuclear medicine department and administered to a patient, as one would for a bone scan, and it is easy to produce, cheap to administer, and accessible. Other similar analogs of glucosamine, such as N-[2,4,5-trihydroxy-6-(hydroxymethyl) tetrahydro-2H-pyran-3-yl] acrylamide, have been demonstrated to have anti-arthritic and immunomodulatory effects in adjuvant-induced arthritis but are yet to be tested in humans as imaging agents (9).In this study, we extended our prior pilot investigations and evaluated 99m Tc-glucosamine imaging modality for its clinical utility, limitations, and applications, particularly in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Tc-glucosamine joint uptake was correlated with MRI, bone scans, and in three cases, the effect of anti-tumor necrosis factor (anti-TNF) treatment on scanning before and after therapy. Material and MethodsEthics approval All patients provided their written informed consent. The Western Sydney Local Health District Human Research Ethics Committee granted ethics approval for this study. Study populationPatients fulfilling the American College of Rheumatology revised criteria for...

Purpose: It was the aim of this study to determine any possible correlation between the peaks and changes in intraocular pressure (IOP) of a water drinking test and intravenous methylprednisolone pulse therapy (IVMPT) IOP response. Methods: Patients with rheumatic disorders scheduled for IVMPT with normal ocular examination received a WDT before and after 3 days of IVMPT. The maximum value of IOPs detected during the WDT or IVMPT was regarded as peak IOP, and IOP change was defined as the difference between peak IOP and baseline IOP. Results: The mean ± standard deviation (SD) IOPs on the first (21.9 ± 4.6 mm Hg; p = 0.04), second (21.9 ± 4.1 mm Hg; p = 0.03) and third (21.3 ± 4.2 mm Hg; p = 0.01) days of 20 enrolled patients were greater than that at baseline (19.3 ± 2.8 mm Hg). The mean ± SD of peak IVMPT IOP response was 23.9 ± 3.7 mm Hg, and IVMPT IOP change was 4.6 ± 3.7 mm Hg. These values for the first and second WDTs were 22.9 ± 4.9 and 3.9 ± 4.07 as well as 24.1 ± 4.6 and 3.00 ± 2.9 mm Hg, respectively. A significant correlation was observed between the first WDT and IVMPT IOP changes (r = 0.5, p = 0.007) and peak IOPs (r = 0.6, p = 0.001). Conclusion: WDT, a low-cost and feasible test in clinical practice, may be a useful tool in determining the IOP peak and change following IVMPT.