Evaluation of Immunological Biomarkers (Tumor Necrosis Factor-α, Anti-Cyclic Citrullinated Peptide, and Adenosine Deaminase) and Their Association with Disease Activity (DAS28) in Individuals with Rheumatoid arthritis

Abstract

Background: Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease characterized by persistent synovial inflammation and progressive joint destruction. This study investigates the association between tumor necrosis factor-alpha (TNF-α), anti-cyclic citrullinated peptide antibodies (anti-CCP), adenosine deaminase (ADA), and the Disease Activity Score-28 (DAS28) in RA patients. Understanding these biomarker correlations provides valuable insights into disease activity assessment and facilitates personalized therapeutic strategies.

Objectives: The study aims to assess the relationships between TNF-α, Anti-CCP, ADA, and

DAS28 in patients with rheumatoid arthritis in Kirkuk, Iraq.

Methods: This case-control study comprised 135 subjects (divided into three groups: 45 newly diagnosed not previously treated patients with rheumatoid arthritis, 45 patients undergoing treatments for 3 months, and 45 healthy rheumatoid factor (RF)–negative controls from the general population. Biomarker levels—TNF-α, anti-CCP, and ADA—were determined using a sandwich enzyme-linked immunosorbent assay (ELISA) with monoclonal antibodies.

Results: In the comparison of patients with rheumatoid arthritis (RA) with healthy controls, significant elevations in means (before, after, control) of TNF-α (849.0, 120.4, 64.3 ng/ml), anti-CCP (531.2, 273.4, 91.2 ng/ml), and ADA (14.9, 1.6, 1.3 ng/ml) were observed. Conversely, significant decreases in these levels were seen after the therapy. A significant association was noted between TNF-α and DAS28 before medication treatment, but anti-CCP exhibited a correlation post-therapy. ADA demonstrated a robust correlation. Evidence indicates that TNF-α and anti-CCP are significant predictive markers for monitoring disease activity in rheumatoid arthritis (RA).

Conclusions: TNF-α and anti-CCP are reliable biomarkers for monitoring treatment response and disease activity in rheumatoid arthritis. Significant post-treatment reductions in these markers’ indicators indicate successful immunosuppression, while ADA normalization implies reinstated immunological modulation. The diminished link between TNF-α and DAS28 following therapy underscores effective cytokine regulation, while the post-treatment relationship of anti-CCP with DAS28 reinforces its significance in long-term illness monitoring. ADA demonstrated restricted efficacy in evaluating joint-specific activity. Moreover, increased BMI correlated with worse inflammatory and hematologic profiles, underscoring the impact of obesity on RA pathogenesis. These insights offer crucial region-specific information for enhancing RA management techniques.