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Open Access Commentary

Laboratory biomarkers or imaging in the diagnostics of rheumatoid arthritis?

Ladislav Šenolt12*, Walter Grassi34 and Peter Szodoray5

Author Affiliations

1 Institute of Rheumatology, Prague, Czech Republic

2 First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic

3 Clinica Reumatologica, Scuola di Specializzazione in Reumatologia, Ancona, Italy

4 Università Politecnica delle Marche, Ancona, Italy

5 Institute of Immunology, Rikshospitalet, Oslo University Hospital, Oslo N-0027, Norway

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BMC Medicine 2014, 12:49  doi:10.1186/1741-7015-12-49

Published: 18 March 2014

Abstract

Rheumatoid arthritis (RA) is a common autoimmune disease in which a heterogeneous course and different pathogenic mechanisms are implicated in chronic inflammation and joint destruction. Despite the diagnostic contribution of anti-citrullinated protein/peptide antibodies (ACPAs) and rheumatoid factors, about one-third of RA patients remain seronegative. ACPAs belong to a heterogeneous family of autoantibodies targeting citrullinated proteins, including myelin-basic protein, several histone proteins, filaggrin and fibrin, fibrinogen or vimentin. In addition to ACPAs, antibodies directed against other post-translationally modified-carbamylated proteins (anti-CarP) were detected in up to 30% of ACPA-negative patients. Using phage display technology, further autoantibodies were recently discovered as candidate biomarkers for seronegative RA patients. Furthermore, in clinical practice, ultrasound may reveal subclinical synovitis and radiographically undetected bone erosions. To improve diagnostic certainty in undifferentiated arthritis and seronegative patients, ultrasound imaging and several new biomarkers may help to identify at risk patients and those with early disease. In this commentary we summarize recent advances in joint ultrasound and future potential of serological biomarkers to improve diagnosis of RA.

Keywords:
Rheumatoid arthritis; Autoimmunity; Disease activity; Laboratory biomarkers; Ultrasound imaging