Symptomatic Pachydermodactyly: A Case Report
Akiyoshi ItoHirotaka TsunoYusuke YanoShinichi NogiYoshihiko TabiraHanako OhmatsuShogo HondaAyako HoritaIkuo SaitoToshihiro Matsui
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Abstract:
Pachydermodactyly, an uncommon variant of digital fibromatosis, predominantly affects young men and results in fibrous swelling on the sides of the proximal interphalangeal joints. It is generally considered benign and asymptomatic, requiring only regular follow-up. Nevertheless, the absence of established diagnostic criteria has led to misdiagnoses, prompting the administration of unnecessary medications. In this report, we present a 14-year-old Japanese male with symptomatic pachydermodactyly, necessitating careful differentiation from juvenile idiopathic arthritis (JIA) due to the presence of morning stiffness. Despite exhibiting typical pachydermodactyly features, the patient's age and symptoms suggested rheumatoid factor-negative polyarticular JIA. However, the lack of inflammatory findings precluded a JIA diagnosis. Following confirmation of the absence of uveitis and progression of bone destruction, the morning stiffness spontaneously resolved without active treatment. However, the patient underwent surgery for aesthetic reasons to alleviate the persistent swelling. Our case highlights the nuances of symptomatic pachydermodactyly, with a literature review revealing similarities between symptomatic and asymptomatic cases. This challenges the suitability of asymptomatic status as a definitive diagnostic criterion. Our findings contribute to the ongoing efforts in establishing diagnostic criteria for pachydermodactyly, aiming to reduce misdiagnoses and unnecessary medications in patients.Keywords:
Morning stiffness
Rheumatoid factor
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Rosette (schizont appearance)
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Background: Rheumatoid arthritis is one of the most common autoimmune diseases. Early diagnosis can prevent side effects and disability. Anti-cyclic citrullinated peptide antibody is a specific marker to diagnose rheumatoid arthritis. This study was carried out to evaluate the efficacy of anti-cyclic citrullinated peptide in comparison with rheumatoid factor in rheumatoid arthritis patients referred to Behshti Hospital of Kashan city during 2006-7. Materials and Methods: This diagnostic value study was done on 98 randomly selected rheumatoid arthritis patients and 75 patients with other rheumatic diseases. In this study rheumatoid factor titer>35 IU/ml and anti-cyclic citrullinated peptide>6.25 IU/ml were considered positive. Results: Anti-cyclic citrullinated peptide compared to rheumatoid factor had a higher sensitivity (73.5 vs. 69.4), specificity (88 vs. 84), positive predictive value (88.9 vs. 85), and negative predictive value (71.7 vs. 67.7) for rheumatoid arthritis. The use of rheumatoid factor and anti-cyclic citrullinated peptide test together increased the specificity and positive predictive value for diagnosis of rheumatoid arthritis to 93.3 and 92.4, respectively. The mean anti-cyclic citrullinated peptide showed a significant difference in Rheumatoid arthritis (46.8 IU/ml( in comparison to non rheumatoid arthritis patients (5.3 IU/ml).Conclusion: Anti-cyclic citrullinated peptide had a better diagnostic value when compared to rheumatoid factor for detection of rheumatoid arthritis. Also combined use of rheumatoid factor and anti-cyclic citrullinated peptide had a higher specificity and positive predictive value than each alone for the diagnosis of rheumatoid arthritis.
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Background: Rheumatoid arthritis (RA) is a polyarticular autoimmune disease that affects about 1% of the adult population. The disease is characterized by synoviocyte hyperplasia, mainly synovial fibroblasts, resulting in bone and joint destruction. Recent studies have shown that cytokines and other systemic inflammation mediators have a key role in the development ofrheumatoid arthritis. Recently, Anti-Citrullinated Protein Antibodies (anti-CCP) have come into use for the diagnosis of rheumatoid arthritis (RA). It has been reported that anti-CCP has quite a high specificity for RA (98%), together with sensitivity similar to that for rheumatoid factor (RF). The study aimed to determine the frequency of positive anti-CCP antibodies in rheumatoid arthritis patients with negative rheumatoid factor.
Methods: 91 patients (both male and females) aged 40-70years with negative RF were clinically diagnosed with rheumatoid arthritis. Patients with positive rheumatoid factor and joint injuries were disclaimed. The consultant pathologist used a second-generation enzyme-linked immunosorbent assay (ELISA) to assess the serum levels of anti-CCP antibodies, >20IU/ ml is considered positive p-value of 0.05 were considered statistically significant.
Results: In the study, the age range was 40 to 70 years, averaging 53.44 ± 7.16 years. 59 (64.84%) of the patients were between the ages of 40 and 55. Of 91 patients, 56 (61.54%) were women, and 35 (38.46%) were men with aratio of 1.6:1 man to women. In patients with negative rheumatoid factors, 27 (40.66%) patients were found to have the levels of positive anti-CCP antibodies.
Conclusion: Patients with negative rheumatoid factor showed the high frequency of positive anti-CCP.
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Objective To investigate the sensitivity and specificity of anti-CCP antibody and rheumatoid factor in laboratory diagnosis of rheumatoid arthritis,and their correlation.Methods Determination results of anti-CCP antibody and rheumatoid factor were statistically analysed in 102 healthy subjects,128 cases with rheumatoid arthritis and 151 patients without rheumatoid arthritis.Anti-CCP antibody and rheumatoid factor were detected by ELISA and immunoturbidimetry,respectively.Results The sensitivity of Anti-CCP antibody and rheumatoid factor for rheumatoid arthritis was 76.6% and 86.7%(P0.05),specificity 94.9% and 69.9%(P0.01),respectively.The correlation coefficient between the quantitative results of anti-CCP antibody and rheumatoid factor was 0.187(P0.05)in rheumatoid arthritis.The positive rate of anti-CCP antibody or rheumatoid factor showed no significant difference between different sex or age.Conclusion The specificity of anti-CCP antibody is markedly better than rheumatoid factor for rheumatoid arthritis,as the sensitivity is reverse.No significant correlation is found in the quantitative results between anti-CCP antibody and rheumatoid factor in rheumatoid arthritis.
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Objectives. Smokers have an increased incidence of rheumatoid factor (RF) and rheumatoid arthritis (RA) and one report has also indicated that smoking may also adversely influence the severity of RA.
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To assess the prevalence and association of anti-cyclic citrullinated peptides and rheumatoid factor in Saudi rheumatoid arthritis patients.Over three years (February 2011 - February 2014). Demographic and clinical features, drugs, rheumatoid factor-positivity, and anti-cyclic citrullinated peptides-positivity were recorded for 205 Saudi rheumatoid arthritis patients (185 females; mean age was 45 years and mean disease duration was 5 years). Anti-cyclic citrullinated peptides and rheumatoid factor were assessed in serum. Disease activity scores for 28 joints was used. There were 36% rheumatoid factor+ve and 45% anti-cyclic citrullinated peptides+ve. 21.5% of the rheumatoid factor-ve subjects were anti-cyclic citrullinated peptides+ve. 13.3% of the rheumatoid factor positive patients were anti-cyclic citrullinated peptides-ve and 86.7% were anti-cyclic citrullinated peptides+ve. Significant association (P < 0.05) of anti-cyclic citrullinated peptides-positivity and rheumatoid factor-positivity with each other, and with gender, use of disease–modifying antirheumatic drugs, hydroxychloroquine and methotrexate. No direct impact of anti-cyclic citrullinated peptides status on the disease activity scores for 28 joints or its constituents (P > 0.5); nevertheless, anti-cyclic citrullinated peptides positive patients appear to represent a greater need for combination disease modifying drugs.
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Citrullinated proteins have been discovered in the joints of patients with rheumatoid arthritis but not in other forms of joint disease. The citrullinated proteins in the joints correspond to the presence of the citrulline antibodies in the blood and suggest a possible role for these antibodies in the development of rheumatoid arthritis. The present study assessed the recent diagnostic value of anti-cyclic citrullinated antibodies (CCP) compared with rheumatoid factor (RF) in patients with rheumatoid arthritis. One hundred blood samples were collected from RA patients and thirty from apparently healthy group. Sera from each subject were tested for anti- CCP and RF by enzyme linked immunosorbent assay (ELISA). The majority of patients were females (84%), with a female: male ratio 5.2:1. The results indicated that anti-CCP postivity for RA patients was (69%) when compared with the healthy group (0.0%), which was highly significant in RA in comparison with control groups (P<0.001). The current study revealed that the sensitivity and specificity of Anti-CCP appeared the highest (69%) in comparison with low (47%) sensitivity for RF. Moreover, the specificity of Anti-CCP was very high (100%), while the specificity of RF was high (90%).
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Abstract A human monoclonal IgMκ paraprotein with rheumatoid factor (RF) activity was used to elicit anti‐idiotypic antibodies in rabbits. The antiidiotypic anti‐serum thus obtained reacted with samples from 40% of 72 rheumatoid arthritis patients, but not with any of the samples from 22 aged control subjects having serum RF. Our findings suggest that, despite the similarities between RF from rheumatoid arthritis patients and that from healthy individuals, the expression of V region genes may be different in healthy subjects and those with the disease.
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Rheumatoid arthritis is a systemic, chronic inflammatory autoimmune disease affecting many tissues but principally attacking the joints. Auto antibodies such as rheumatoid factor and anti-cyclic Citrullinated peptide antibodies have important diagnostic value. This cross-sectional analytical study was performed at a single medical institution in central Iran (Shahid Sadoughi Hospital, Yazd, Iran) in order to compare the diagnostic value of anti-cyclic citrullinated peptide antibodies and rheumatoid factor in patients with rheumatoid arthritis. Serum levels of anti-cyclic citrullinated peptide antibodies were determined by enzyme-linked immunosorbent assay, and levels of rheumatoid factor were determined by turbidimetry on a latex-enhanced agglutination assay in 266 patients with rheumatoid arthritis and 134 patients with non-rheumatoid arthritis rheumatic diseases. Among the 266 patients with rheumatoid arthritis, 188 patients (70.7%) were tested positive for anti-cyclic citrullinated peptide antibodies, and 123 patients (46.2%) were tested positive for rheumatoid factor. The sensitivity, specificity, positive predictive value and negative predictive value of anti-cyclic citrullinated peptide antibodies for diagnosing rheumatoid arthritis were 70.76%, 85.07%, 90%, and 59% respectively. Those for rheumatoid factor were 46.26%, 90.29%, 90%, and 45% respectively. The anti-cyclic Citrullinated peptide antibodies measurement is a useful test for diagnosing rheumatoid arthritis. Due to its high positive predictive value and negative predictive value, it is an important diagnostic test and gives accurate diagnosis of the disease. However, this does not mean that anti-cyclic citrullinated peptide antibodies can replace rheumatoid factor in the diagnosis of rheumatoid arthritis, because not all rheumatoid arthritis patients have anti-cyclic Citrullinated peptide antibodies. The two tests therefore appear to be complementary.
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