中华劳动卫生职业病杂志
2022
年
13
月第
40
卷第
13
期
Chin J Ind Hyg Occup Dis
，
2022
，
662-665
662
THE DIAGNOSTIC VALUE OF ANTIBODIES TO MODIFIED CITRULLINATED
VIMENTIN IN CHILDREN WITH JUVENILE ARTHRITIS
Akhmedova D.I.
1,2
, Ibragimov A.A.
1
, Akhmedova N.R.
1,2
, Gazieva K.SH
1
.
1
Republican Specialized Scientific and Practical Medical Center of Pediatrics
2
Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
https://doi.org/10.5281/zenodo.7060265
Abstract:
The article presents the study results of the value of Anti-MCV in children with
juvenile arthritis, depending on the variant of the disease. An analysis of obtained results reveal that
in children with juvenile arthritis, Anti-MCV indicates the likelihood of the joint syndrome
formation, that frequently leads to the development of significant functional insufficiency of the
joints, which is the justification for the early appointment of active, often aggressive therapy in
order to prevent disability of the patient. The level of Anti-MCV can be as a basis for the using of
this indicator in monitoring activity and assessing the effectiveness of treatment.
Keywords:
children, juvenile arthritis, antibodies to modified citrullinated vimentin
.
Background
Diagnosis of juvenile arthritis (JA) presents certain difficulties, especially in the early stages
of the disease due to the lack of modern diagnostic criteria and specific laboratory tests. The
number of laboratory tests that have high sensitivity and specificity which help in the early
recognition of a variant of JA in pediatric rheumatology is limited [2, 4, 5, 10, 11, 12, 16,18].
In recent years, a certain diagnostic importance has been attached to new immunological
indicators– antibodies to cyclic citrullinated peptide (Anti-CCP) and antibodies to modified
citrullinated vimentin (Anti-MCV) [1, 2, 3, 6, 14, 15, 17].
Determination of Anti-MCV (anti-Sa antibodies) is one of the most promising (in diagnostic
and prognostic terms) tests in patients with rheumatoid arthritis (RA). Anti-MCV are antibodies that
interact with synthetic peptides containing citrulline [1,7, 8, 9, 15, 16, 19. 20].
The literature discusses the role of Anti-MCV for the diagnosis of RA in adults as a new
immunological marker along with RF and Anti-CCP, especially in the early stages of the disease
[20].
According to the literature, Anti-MCV has a sufficiently high sensitivity (53.7-82.0%) and
specificity (89.8-98.7%) for the diagnosis of RA exceeding these indicators for Anti-CCP.
Moreover, the specificity of Anti-MCV increases and exceeds that for rheumatoid factor (RF) when
using a higher level of “cut off” [4,7,8, 16,17, 20].
The detection of antibodies to modified citrullinated vimentin and RF significantly increases
the probability of a diagnosis of rheumatoid arthritis [1, 3, 8, 11, 16, 18].
Based on the above, the study of the role of Anti-MCV in children with JA is of great
importance.
The aim of our study was to determine the concentration and frequency of increase in the
level of Anti-MCV and its diagnostic significance in children with JA.
Research materials and methods
The study included 85 children who were on inpatient treatment in the Department of
Cardiorheumatology of the RSSPMC of Pediatrics. The age of children were from 2 to 18 years
(med. 8, 5 + 1, 1 years). The duration of the disease varied from 6 months to 15.5 years (average
5.4+0.9 years).
Anti-MCV was determined in 85 patients with JA (57-girls, 38-boys). To determine the
differences in the level of Anti-MCV between the variants of JA, the children were divided into 2
groups depending on the variant of the disease:
- Group 1 – 37 (43.5%) patients with the articular variant of JA;
中华劳动卫生职业病杂志
2022
年
13
月第
40
卷第
13
期
Chin J Ind Hyg Occup Dis
，
2022
，
662-665
663
- Group 2 – 48 (56.5%) patients with systemic JA (SoJA).
Statistical processing of the results was carried out using the software package for IBM PC
"Statistica 7.0", "BIOSTAT". To describe the nature of the distribution of quantitative features,
standard methods of variational statistics were used with the determination of the arithmetic mean
(M), the mean (standard) quadratic deviation (σ), for an incorrect distribution – median (Me) and
interquartile range (IR). The reliability of the differences between the groups when comparing
quantitative parameters was assessed using the Student's T-test. If the significance level of p was
less than 0.05 (p<0.05), the differences were considered statistically significant.
Results and discussion
Vimentin, usually performing a structural role, is found in large quantities in the synovial
membrane of the joints. Under the influence of inflammatory mediators, vimentin undergoes
citrullination, a process in which the amino acid arginine in vimentin is converted into citrulline.
Citrullinated vimentin acts as an antigen for autoantibodies in rheumatoid arthritis [1, 3, 4].
A study of the frequency of elevated Anti-MCV levels in children with JA showed that an
increased Anti-MCV levels were detected in 12 (32.4%) patients with the articular variant of JA,
which was 2.6 times more common than in children with SoJA (p≤0.01) (Fig.1).
Fig.1. The number of patients (%) with a high level of Anti-MCV, depending on the
variant of JA.
Significantly more often in RF positive patients than in RF negative ones (p=0.001),
elevated levels of Anti-MCV were detected.
The concentration of Anti-MCV in the serum in the articular variant of JA ranged from 1.7
to 413.2 units/ml and its average was 39.4 ± 2.8 units/ml. In contrast, in children with SoJA, the
levels of Anti-MCV in the serum were much lower and the fluctuations ranged from 0.8 to 30.5
units/ml. At the same time, its average was 7.1± 0.5 units/ml (p<0.001) (Table 1).
An average concentration of Anti-MCV in children with JA, depending on the variant
of the disease
Indicator
Group 1
Group 2
р
Anti-MCV,
units/ml
39,4±2,8
7,1±0,5
<0,001
Note: p - accuracy of the indicators between the compared groups
The presence of Anti-MCV is associated with the development of destructive changes in the
joints and rapid progression of JA. The Anti-MCV concentration more accurately reflects the
activity of the disease. To assess the activity of the disease, the indicators of each patient were
analyzed separately [4, 7, 11, 17, 20].
The study of the antibodies level in patients depending on the variant of the disease showed
that 6 (16.2%) children with the articular variant of JA had a high level of Anti-MCV (more than 30
32,70%
12,50%
0,00%
5,00%
10,00%
15,00%
20,00%
25,00%
30,00%
35,00%
Group 1
Group2
Group 1
Group2
中华劳动卫生职业病杂志
2022
年
13
月第
40
卷第
13
期
Chin J Ind Hyg Occup Dis
，
2022
，
662-665
664
units / ml) 5-fold exceeding the standard values, the 9-fold increase was seen in 1 (2.7%) patient
and 14-fold in another (2.7%), while the rest patients had a low content of (20-30 U/ml) (p<0.001).
The overwhelming majority of patients with the articular variant had a low level of Anti-MCV in
the serum. As the results of the study showed, both the titers of Anti-MCV concentration and the
frequency of their increase are higher in children with the articular variant of disease compared with
the SoJA, which indicate the presence of destructive changes in the joints and the progression of JA.
Therefore, Anti-MCV indicates the probability of joint syndrome formation, which most often
leads to the development of significant functional insufficiency of the joints, which is the reason for
the early appointment of active, often aggressive therapy in order to prevent disability of the patient.
The level of Anti-MCV can be an indicator for monitoring activity and evaluating the effectiveness
of treatment.
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，
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662-665
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