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Arthritis Res Ther. 2017 Nov 22;19(1):257. doi: 10.1186/s13075-017-1463-1.

Serum connective tissue growth factor is a highly discriminatory biomarker for the diagnosis of rheumatoid arthritis.

Author information

1
Department of Medicinal Chemistry, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China.
2
Department of Biochemistry, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, 325035, China.
3
Department of Rheumatology, Jiamusi Central Hospital, Jiamusi, China.
4
Institute of Health and Biomedical Innovation, Translational Research Institute, Queensland University of Technology, Princess Alexandra Hospital, Brisbane, Australia.
5
Centre for Precision Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
6
Department of Orthopaedic Surgery, Shanghai Guanghua Special Hospital for Rheumatoid Arthritis, Shanghai, China.
7
Department of Immunology and Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, China. grassandsun@126.com.
8
Department of Anesthesia and Critical Care, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, China. jinshengwei69@163.com.
9
Department of Biochemistry, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, 325035, China. wz_wjg@163.com.

Abstract

BACKGROUND:

Our previous proteomic study indicated that connective tissue growth factor (CTGF) may be a potential biomarker for rheumatoid arthritis (RA) diagnosis. The aim was to assess the performance of CTGF as a biomarker of RA.

METHOD:

Serum and synovial fluid CTGF was detected using a direct high sensitivity sandwich ELISA kit. Serum CTGF levels were tested for discriminatory capacity and optimal assay cutoffs determined in a training cohort of 98 cases of RA with 103 healthy controls. The assay performance was then validated in a further cohort of 572 patients (with RA (n = 217), ankylosing spondylitis (n = 92), gout (n = 74), osteoarthritis (n = 52), systemic lupus erythematosus (n = 72), or primary Sjögren's syndrome (pSS) (n = 65)).

RESULTS:

Significant elevation of synovial fluid CTGF concentration was found in RA patients, demonstrating excellent diagnostic ability to predict RA (area under the curve (AUC) = 0.97). Similar results were found in serum CTGF detection. At the optimal cutoff value 88.66 pg/mL, the sensitivity, specificity, and the AUC was 0.86, 0.92, and 0.92, respectively, in the training cohort. Similar performance was observed in the validation cohort, with sensitivity, specificity, positive likelihood, and negative likelihood of 0.82, 0.91, 5.74, and 0.12, respectively. Stronger discriminatory capacity was seen with the combination of CTGF and anti-citrullinated protein antibody (ACPA) (AUC = 0.96) than with either ACPA or rheumatoid factor (RF) alone (AUC = 0.80 or 0.79, respectively). The discriminatory performance of serum CTGF was consistent across all inflammatory conditions tested (AUC >0.92 in all cases), with the sole exception of pSS. Serum CTGF did not vary with symptom duration or disease activity.

CONCLUSIONS:

Serum CTGF is a promising diagnostic biomarker for RA, with performance in the current study better than either ACPA or RF.

KEYWORDS:

ACPA; Biomarker; CTGF; Rheumatoid arthritis; Rheumatoid factor

PMID:
29166915
PMCID:
PMC5700625
DOI:
10.1186/s13075-017-1463-1
[Indexed for MEDLINE]
Free PMC Article

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