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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (6): 1023-1028. doi: 10.19723/j.issn.1671-167X.2020.06.006

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Clinical and laboratory characteristics of rheumatoid arthritis with positive antinuclear antibody

Jing-feng ZHANG,Xiu-ling YE,Meng DUAN,Xiao-li ZHOU,Zhong-qiang YAO,Jin-xia ZHAO()   

  1. Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
  • Received:2020-06-12 Online:2020-12-18 Published:2020-12-13
  • Contact: Jin-xia ZHAO E-mail:zhao-jinxia@163.com

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Abstract:

Objective: To analyse the clinical and laboratory characteristics of antinuclear antibody (ANA) positive rheumatoid arthritis (RA) patients. Methods: The clinical and laboratory data of 428 RA cases from Department of of Rheumatology and Immunology Peking University Third Hospital from Jan 2013 to Dec 2018 were collected and used to analyse characters between ANA positive group and ANA negative group. T test was used for the quantitative data in accordance with normal distribution. Wilcoxon rank sum test was used for the quantitative data of non normal distribution. The qualitative data were analyzed by chi square test. But while 1≤theoretical frequency<5, chi square test of corrected four grid table was used. And Fisher exact probability method was used when theoretical frequency<1. Results: The number of ANA positive group was 231 (54%). The female rate was obviously higher in ANA positive group (82.7% vs. 63.5%, χ2=20.355,P<0.01). The rate of metatarsophalangeal joints (MTPJs) involvement was lower in ANA positive group (22.1%) than in ANA negative group (33.0) (χ2=6.414, P<0.05). The incidence of secondary Sj?gren’s syndrome (sSS) was much higher in ANA positive group(19.5% vs. 4.1%, χ2=23.300,P<0.01). The positivity of rheumatoid factor (RF), as well as the positivity of anti-cyclic citrullinated peptide(CCP) antibody was much higher in ANA positive group (77.1% vs. 53.8%, χ2=25.743,P<0.01, 74.9% vs. 59.4%, χ2=11.694,P<0.01, respectively). The levels of immunoglobulin G (IgG) and immunoglobulin M (IgM) of ANA positive group were higher [(15.1±5.1) g/L vs. (13.8±5.3) g/L, t=2.359, P<0.05, 1.25 (0.92) g/L vs. 1.05 (0.65) g/L, Z=-3.449, P<0.01, respectively]. But the levels of hemoglobin (Hb) and platelet (PLT) was lower in ANA positive group[ (109.64±17.98) vs. (114.47±18.48) g/L,t=-2.734, P<0.01; (266.4×109±104.6×109) vs. (295.9×109±100.1×109) /L,t=-2.970, P<0.01, respectively]. Conclusion: The incidence of sSS was obviously higher in ANA positive group than in ANA negative group. Serum IgG of ANA positive group was higher, but Hb and PLT were lower.

Key words: Rheumatoid arthritis, antinuclear antibody, Secondary Sj?gren's syndrome, Rheumatoid factor, anti-cyclic citrullinated peptide antibody

CLC Number: 

  • R593.22

Table 1

Comparison of general situation between ANA+ RA group and ANA- RA group"

Group Number of cases Age/years, M(QR) Gender(female), n(%) Disease duration/years, M(QR) Somking history, n(%)
ANA+ 231 60.0(18.0) 191 (82.7) 5.0 (16.0) 36 (15.6)
ANA- 197 61.0(16.0) 125 (63.5) 5.0 (12.2) 46 (23.4)
Z/χ2 -0.450 20.355 -1.401 4.140
P 0.653 <0.001 0.161 0.042

Table 2

Comparison of joint performance between ANA+ RA group and ANA- RA group"

Group ANA+ ANA- t/Z/χ2 P
Number of cases 231 197
DIPJs, n(%) 16 (6.9) 17 (8.6) 0.433 0.51
PIPJs, n(%) 155 (67.1) 138 (70.0) 0.429 0.513
MCPJs, n(%) 134 (58.0) 121 (61.4) 0.514 0.473
Wrist joints, n(%) 148 (64.1) 136 (69.0) 1.175 0.278
Elbow joints, n(%) 92 (39.8) 89 (45.2) 1.247 0.264
Shoulder joints, n(%) 88 (38.1) 77 (39.1) 0.044 0.834
TMJs, n(%) 4 (1.7) 7 (3.6) 1.409 0.235
Sternoclavicular joints, n(%) 2 (0.9) 1 (0.5) 0 1.000
Hip joints, n(%) 41 (17.7) 36 (18.3) 0.02 0.888
Knee joints, n(%) 165 (71.4) 136 (69.0) 0.292 0.589
Ankle joints, n(%) 114 (49.4) 107 (54.3) 1.049 0.306
MTPJs, n(%) 51 (22.1) 65 (33.0) 6.414 0.011
PIPJs(F), n(%) 23 (10.0) 22 (11.2) 0.166 0.684
DIPJs(F), n(%) 0 (0.0) 2 (1.0) 0.211
Tender joint count, M(QR) 11.0 (19.0) 9.0 (13.0) -1.096 0.273
Swollen joint count, M(QR) 5.0 (10.0) 5.0 (12.0) -0.055 0.956
Joint deformity, n(%) 75 (32.5) 65 (33.0) 0.013 0.908
Symmetry, n(%) 222 (96.1) 191 (97.0) 0.227 0.633
VAS, M(QR) 5.0 (5.5) 5.0 (5.0) -1.317 0.188
DSA28, x±s 5.4±1.5 5.3±1.5 1.331 0.184

Table 3

Comparison of extraarticular manifestations between ANA+ RA group and ANA- RA group"

Group Number
of cases		 Vasculitis, n(%) Rheumatoid
nodules, n(%)		 Peripheral
neuropathy, n(%)		 Pericarditis, n(%) Pleural
effusion, n(%)		 ILD, n(%) Anemia, n(%)
ANA+ 231 2 (0.9) 18 (7.8) 5 (2.2) 6 (2.6) 9 (3.9) 53 (22.9) 120 (51.9)
ANA- 197 0 (0.0) 10 (5.1) 4 (2.0) 0 (0.0) 4 (2.0) 47 (23.9) 92 (46.7)
χ2 1.283 0.000 3.481 1.257 0.05 1.171
P 0.502 0.257 1.000 0.062 0.262 0.824 0.279

Table 4

Comparison of complications between ANA+ RA group and ANA- RA group"

Group Number of cases sSS, n(%) Venous thrombosis, n(%)
ANA+ 231 45 (19.5) 8 (3.5)
ANA- 197 8 (4.1) 8 (4.1)
χ2 23.300 0.106
P <0.001 0.745

Table 5

Comparison of laboratory examination indexes between ANA+ RA group and ANA- RA patients"

Group ANA+ ANA- t/Z/χ2 P
Number of cases 231 197
RF, n(%) 178 (77.1) 106 (53.8) 25.743 <0.001*
anti-CCP antibody, n(%) 173 (74.9) 117 (59.4) 11.694 0.001*
AKA, n(%) 51 (25.5) 30 (17.9) 3.107 0.078
WBC/(×109/L), M(QR) 6.35 (3.56) 6.74 (2.64) -1.955 0.051
Hb/(g/L), x-±s 109.6±18.0 114.5±18.5 -2.734 0.007*
PLT/(×109/L),x-±s 266.4±104.6 295.9±100.1 -2.970 0.003*
IgG/(g/L), x-±s) 15.1±5.1 13.8±5.3 2.359 0.019*
IgA/(g/L), M(QR) 3.01 (1.96) 2.89 (2.33) -1.217 0.224
IgM/(g/L), M(QR) 1.25 (0.92) 1.05 (0.65) -3.449 0.001*
C3/(g/L), M(QR) 1.03 (0.35) 1.05 (0.33) -0.719 0.472
C4/(g/L), x-±s 0.22±0.09 0.23±0.09 -1.299 0.195
ESR/(mm/h), M(QR) 44.0 (51.0) 42.0 (56.5) -1.104 0.270
CRP/(mg/dL), M(QR) 2.05 (5.42) 2.40 (6.64) -0.645 0.519
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