2010 ACR/EULAR 류마티스관절염의 분류 체계에 대한 항핵주변인자 검사의 적용에 관한 예비 연구
A Preliminary Study for Applying Antiperinuclear Antibody Test to 2010 ACR/EULAR Classification Criteria for Rheumatoid Arthritis
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배경: 류마티스 인자 검사와 ACPA검사는 ACR/EULAR criteria에서 류마티스관절염의 진단을 위한 혈청학적 검사 항목으로 포함되어 있다. 항핵주변인자(antiperinuclear antibody) 검사는 ACPA 검사의 원조에 해당하는 검사로 류마티스관절염에 대한 높은 특이도를 보이면서 류마티스인자 음성/anti-cyclic citrullinated peptide(anti-CCP) 음성인 류마티스관절염에서 자가항체를 검출할 수 있음에도 불구하고 ACR/EULAR criteria의 혈청학적 검사 항목에 포함되지 않았다. 저자들은 항핵주변인자 검사를 ACR/EULAR criteria에적용하기 위한 방안을 연구하기 위해 본 연구를 시행하였다. 방법: 류마티스관절염이 의심되는 53명의 환자를 대상으로 임상증상 및 검사 결과를 조사하였다. 대상 환자들은 전원 류마티스인자 음성, anti-CCP 검사 음성이면서 항핵주변인자 검사 양성이었다. 항핵주변인자 검사의 형광 강도(1+, 2+, 3+, 4+)에 따라 환자를4개의 그룹으로 구분하였고 항핵주변인자 양성 소견에 대해 1에서4점까지 점수를 부여했을 때 ACR/EULAR criteria의 점수가 6점 이상인 환자의 비율을 조사하였다. 결과: 항핵주변인자 검사의 형광 강도가 증가함에 따라 평균ACR/EULAR criteria 점수가 증가하는 양상을 보였으나 해당 4개의 그룹의 ACR/EULAR criteria 점수는 유의한 차이가 없었다(P >0.05). 항핵주변인자 양성에 대해 2점 및 3점을 ACR/EULAR criteria에적용하도록 하였을 때 6점 이상이 된 환자의 비율은 각각39.6%와 77.4%였다. 결론: ACR/EULAR criteria의 ACPA 검사 항목에 항핵주변인자 항목도 포함시키고 항핵주변인자 검사 양성인 경우 형광 강도와 관계 없이 3점을 부여하는 방안이 바람직할 것으로 사료된다
Abstract
Background: The American College of Rheumatology/European League against Rheumatism classification criteria for rheumatoid arthritis (ACR/EULAR criteria) include the rheumatoid factor (RF) test and the anti-citrullinated peptide/protein antibody (ACPA) test as serologic makers for rheumatoid arthritis. Antiperinuclear factor (APF) test, an originator of ACPA, is highly specific for rheumatoid arthritis and can be detected in RF or anti-cyclic citrullinated peptide (anti-CCP) negative rheumatoid arthritis, but it is not included in the serologic criterion of ACR/EULAR criteria. In this study, we investigated the way for applying the APF test to ACR/EULAR criteria. Methods: We analyzed clinical symptoms and laboratory findings of 53 patients who were suspected having rheumatoid arthritis. All patients were negative for the RF and anti-CCP and positive for APF. We classified these patients into 4 groups according to the fluorescence intensity of APF test, and gave 1-4 points for APF positivity. The proportion of patients who scored 6 or greater in ACR/EULAR criteria in relation to APF scores was evaluated. Results: Median scores of ACR/EULAR criteria showed a tendency to increase as the level of fluorescence intensity of APF rises, but ACR/EULAR scores of 4 groups were not different significantly from each other (P >0.05). The proportion of patients who scored 6 or greater in ACR/EULAR criteria were 39.6% and 77.4%, when scores of APF positivity were 2 and 3 points, respectively. Conclusions: We think it is reasonable to include APF test in the ACPA of ACR/EULAR criteria and give 3 points for APF positivity, regardless of its fluorescence intensity.
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