Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
J Investig Med. 2020 Jan;68(1):37-44. doi: 10.1136/jim-2019-001097. Epub 2019 Jul 19.
Early diagnosis and detection of rheumatoid arthritis (RA) activity which is a potential therapeutic target, depends mainly on clinical presentation. However, laboratory tests may contribute to diagnosis and disease activity assessment of RA. This study aims to evaluate the accuracy of serum Midkine as serological marker for RA diagnosis and its activity detection. All patients with RA were recruited during the period from January 2016 to August 2018 in addition to healthy subjects as control. Serum Midkine level was estimated using enzyme immunoassay. The accuracy was determined for serum Midkine against the used American College of Rheumatology/European League Against Rheumatism 2010 classification criteria for RA diagnosis and disease activity score derivative for 28 joints-erythrocyte sedimentation rate (ESR) score for assessment of RA disease activity. A total of 211 of patients with RA (group I) were enrolled in this study with 112 healthy subjects (group II). Patients with RA were divided into two subgroups according to the disease activity; patients with active RA (group IA) and RA in remission (group IB). We detected that the area under curve (AUC) of serum Midkine level (AUC=0.851) was significantly lower than that of rheumatoid factor IgM and anti-cyclic citrullinated peptide IgG for RA diagnosis. However, Midkine presents a significantly higher diagnostic accuracy (AUC=0.939) in detecting RA activity than that offered by C reactive protein (CRP) or ESR. Our study suggested that serum Midkine is a potential serological marker for detection of active inflammatory state with higher diagnostic accuracy than other inflammatory markers as CRP or ESR. Therefore, it can be used as an inflammatory marker for detection of disease activity rather than diagnosis of RA.
早期诊断和检测类风湿关节炎 (RA) 的活动是一个潜在的治疗靶点，主要依赖于临床表现。然而，实验室检查可能有助于 RA 的诊断和疾病活动评估。本研究旨在评估血清 Midkine 作为 RA 诊断和活动检测的血清标志物的准确性。所有 RA 患者均于 2016 年 1 月至 2018 年 8 月期间招募，并以健康受试者作为对照。使用酶联免疫吸附法估计血清 Midkine 水平。确定了血清 Midkine 对美国风湿病学会/欧洲抗风湿病联盟 2010 年 RA 诊断分类标准和用于评估 RA 疾病活动的 28 个关节-红细胞沉降率 (ESR) 评分衍生的疾病活动评分的准确性。共招募了 211 例 RA 患者（I 组）和 112 名健康受试者（II 组）。根据疾病活动，将 RA 患者分为两组；活动期 RA 患者（IA 组）和缓解期 RA 患者（IB 组）。我们发现血清 Midkine 水平的曲线下面积 (AUC)（AUC=0.851）明显低于类风湿因子 IgM 和抗环瓜氨酸肽 IgG 对 RA 的诊断。然而，Midkine 在检测 RA 活动方面的诊断准确性（AUC=0.939）明显高于 CRP 或 ESR 提供的准确性。我们的研究表明，血清 Midkine 是一种潜在的血清学标志物，可检测活跃的炎症状态，其诊断准确性高于 CRP 或 ESR 等其他炎症标志物。因此，它可作为检测疾病活动的炎症标志物，而不是 RA 的诊断标志物。
