Hematolojik Malignitesi Ve Solid Organ Tümörü Olan Hastalarda RF VE ANTİ-CCP Pozitiflik Oranlarının Saptanması

Öz

Giriş ve Amaç: Paraneoplastik artrit bulguları birçok romatizmal hastalığı taklit edebilmektedir. RF ve anti-CCP vaka sunumlarında ve çalışmalarda paraneoplastik artriti diğer romatolojik hastalıklardan ayrımında kullanılabilirliği araştırılan belirteçlerdendir. Çalışmalarda romatolojik nedenli artritlerde bu belirteçlerin sıklığı artmış gösterilmekle birlikte hematolojik malignite ve solid organ tümörü gelişen hastalarda RF ve anti-CCP sıklığını gösteren çalışma yoktur. Bizde çalışmamızda hematolojik malignite ve solid organ tümörü gelişen hastalarda RF ve anti-CCP sıklığını saptamayı planladık. Gereç ve Yöntemler: Çalışmaya Gaziantep Üniversitesi Şahinbey Eğitim ve Araştırma Hastanesi hematoloji ve onkoloji polikliniklerine başvuran yeni tanı almış hematolojik ve solid organ malignitesi olan 102 hasta alındı. Kontrol grubu olarak ise aynı merkezde iç hastalıkları polikliniğine başvuran malign hastalık öyküsü olmayan 84 hasta alındı. Bulgular: 186 hastanın tamamında Anti-CCP negatif olarak saptandı. RF çalışma grubunda 12 (Hematolojik malignite:3, Solid organ tümörü:9), kontrol grubunda 10 olmak üzere 22 hastada pozitif saptandı. Çalışma grubunda RF pozitifliği %11,76 olarak saptandı. Hematolojik malignite ve solid organ tümörü olan hastalarda RF ve Anti-CCP sıklığı normal popülasyona göre anlamlı farklılık göstermemektedir. Sonuç: Hasta grubu ve kontrol grubunda antikor pozitiflik oranlarının benzer saptanması paraneoplastik artrit ayırıcı tanısında kullanılan ve daha yaygın kullanılabilirliği araştırılan bu belirteçlerin artrit olmaksızın malignitelerle direkt ilişkili olmadığını düşündürebilir. Ancak daha çok hasta ve farklı klinik tablolarda çalışmanın tekrarlanması faydalı olabilir.

Anahtar Kelimeler

• Paraneoplastik Sendromlar
• Artrit
• Romatoid faktör
• Anti-Sitrüline Protein Antikorlar

Determination Of RF And ANTI-CCP Positivity Rate In Patients With Hematological Malignancies And Solid Organ Malignancies

Öz

Objective: Paraneoplastic arthritis may mimic many rheumatic diseases. In case reports and studies published to date, RF and anti-CCP have been studied as markers in differentiating paraneoplastic arthritis from other rheumatic disease. Although these studies have demonstrated increased levels of these markers in arthritis with rheumatoid origin, there is no study showing the prevalence of RF and anti-CCP in patients with hematological malignancy or solid organ tumors. Materials and Methods: In this study, we aimed to evaluate the prevalence of RF and anti-CCP in patients with hematological malignancy and solid organ tumors. The study included total 102 patients with a hematological or solid organ malignancy who were admitted to the Hematology and Oncology outpatient clinics at Gaziantep University Hospital. The control group comprised of a total of 84 patients without a history of malignancy who were admitted to internal medicine outpatient clinics. Results: All participants were anti-CCP negative. 12 patient from study group (hematological malignancy=3, solid organ tumor=9) and 10 patients from control group tested positive for RF. The rate of RF positivity was 11.76% in the study group. The prevalence of RF and anti-CCP positivity in this group of patients with hematological malignancy or solid organ tumor was not significantly different, compared to the healthy population. Conlusion: These findings may suggest that these markers which are used in the differential diagnosis of paraneoplastic arthritis and examined for more extensive utility may not be related to malignancies in the absence of arthritis. However, further large-scale studies conducted in the clinical setting are required to confirm these findings.

Anahtar Kelimeler

• Paraneoplastic Syndromes
• Arthritis
• Rheumatoid Factor
• Anti-Citrullinated Protein Antibodies

Kaynakça

1. 1. Szekanecz, E, Andras, C, Sandor, Z, et al., Malignancies and soluble tumor antigens in rheumatic diseases, Autoimmun Reviews, 2006, 6, 42-47.
2. 2. Bojinca, V, Janta, I, Rheumatic diseases and malignancies, Maedica (Bucur), 2012, 7(4), 364-71.
3. 3. Valeriano, J. Malignancy and rheumatic disease, Cancer Control, 1974, 236-244.
4. 4. Kisacik, B, et al., Diagnostic dilemma of paraneoplastic arthritis: case series, International journal of rheumatic diseases, 2014, 17(6), 640-5.
5. 5. Maibom-Thomsen, S.L, Trier, N.H, Holm, B.E, Hansen, K.B, Rasmussen, M.I, Chailyan, A, et al., Immunoglobulin G structure and rheumatoid factor epitopes, PLoS One, 2019, 14(6), e0217624.
6. 6. Wasserman, A, Rheumatoid Arthritis: Common Questions About Diagnosis and Management, American Family Physician, 2018, 97(7), 455-462.
7. 7. Rönnelid, J, Turesson, C, Kastbom, A, Autoantibodies in Rheumatoid Arthritis- Laboratory and Clinical Perspectives, Frontiers in Immunology, 2021,12, 685312.
8. 8. Yang, X, Cai, Y, Xue, B, Zhang, B, Diagnostic value of anti-cyclic citrullinated peptide antibody combined with rheumatoid factor in rheumatoid arthritis in Asia: a meta-analysis, Journal of Internal Medicine Research, 2021, 49(9), 3000605211047714.

9. 9. Allard-Chamard, H, Boire, G. Serologic Diagnosis of Rheumatoid Arthritis, Clinical Laboratory Medicne, 2019, 39(4), 525-537.
10. 10. Mun, S, Lee, J, Park, M, Shin, J, Lim, M.K, Kang, H.G, Serum biomarker panel for the diagnosis of rheumatoid arthritis, Arthritis research and therapy, 2021, 23(1), 31.
11. 11. Silvério-António, M, Parlato, F, Martins, P, et al., Gastric Adenocarcinoma Presenting as a Rheumatoid Factor and Anti-cyclic Citrullinated Protein Antibody-Positive Polyarthritis: A Case Report and Review of Literature, Frontiers in Medicine (Lausanne), 2021, 8, 627004.
12. 12. Schellekens, G.A, Visser, H, de Jong, B.A.W, et al., The diagnostic properties of rheumatoid arthritis antibodies recognizing anti-cyclic citrulinated peptide, Arthritis Rheumatology, 2000, 43, 155-163.
13. 13. Lee, D.M, Schur, P.H, Clinical utility of the anti-CCP assay in patients with rheumatic diseases, Annals of the rheumatic diseases, 2003, 62, 870-874.
14. 14. Larson, E, Etwaru, D, Siva, C, et al., Report of anti-CCP antibody positive paraneoplastic polyarthritis and review of the literatüre, Rheumatology International, 2011, 31, 1635-8.
15. 15. Kumar, S, Sethi, S, Irani, F, et al., Anticycliccitrullinated peptide antibody-positive paraneoplastic polyarthritis in a patient with metastatic pancreatic cancer, American Journal of Medical Science, 2009, 338, 511–2.
16. 16. Van Boekel, M.A.M., Vossenaar, E.R, et al, Autoantibody Systems in Rheumatoid Arthritis: Specificity, Sensitivity and Diagnostic Value, Arthritis Research, 4, 87-93, 2002.
17. 17. Kleinert, S, La Rosée, P, Krüger, K, Rheumatische Krankheitserscheinungen bei hämatologischen Neoplasien [Rheumatoid symptoms in patients with hematologic neoplasms], Zeitschrift für Rheumatologie, 2017, 76(Suppl 2), 38-45.
18. 18. Zhu, J.N, Nie, L.Y, Lu, X.Y, Wu, H.X, Meta-analysis: compared with anti-CCP and rheumatoid factor, could anti-MCV be the next biomarker in the rheumatoid arthritis classification criteria? Clinical chemistry and laboratory medicine, 2019, 57(11), 1668-1679.
19. 19. Brentville, V.A, Metheringham. R.L, Gunn, B, et al., Citrullinated Vimentin Presented on MHC-II in Tumor Cells Is a Target for CD4+ T-Cell-Mediated Antitumor Immunity, Cancer Research, 2016, 76(3), 548-560.
20. 20. Manger, B, Schett, G, Rheumatic paraneoplastic syndromes- A clinical link between malignancy and autoimmunity, Clinical Immunology, 2018, 186, 67-70.