Assessment of specific coagulation activation markers in rheumatoid arthritis

Abstract EN

Aim of Work: To evaluate the coagulation status in adult rheumatoid arthritis (RA) patients by estimating the blood levels of specific coagulation activation markers (CAMs) namely; thrombin anti-thrombin complex (TAT), prothrombin fragments (F1+2) and D-Dimer (DD).

Subjects: The study was carried out at the Out-patient Clinic of the Rheumatology & Rehabilitation Department, Suez Canal University Hospitals.

It included 2 groups: firstly, 24 RA patients group who were diagnosed according to the American College of Rheumatology (ACR) criteria (Arnett et al., 1988).

Secondly, control group consisted of 24 healthy individuals; matched in sex and age with RA patients.

Methods: RA patients were subjected to: complete history, clinical examination, routine laboratory investigations, disease activity evaluation according to Mallya and Mace (1981) and the functional status performance according to Hochberg et al.

(1992).

Both groups were evaluated for: coagulation screening tests [prothrombin time (PT) and activated partial thromboplastin time (APTT)] and the blood levels of TAT, F1+2 and DD.

Results: RA patients group included 5 males (20.8%) and 19 females (79.2%), while the control group was 4 males (16.6%) and 20 females (83.3%).

The age of RA patients ranged between 22-56 years with a mean ±SD (47.12±8.71) and for the control group it was between 25-50 years with a mean ± SD (46.86±8.82).

The disease duration for RA patients ranged between 1-25 years with a mean ± SD (8.83±7.16).

The coagulation screening tests PT and APTT, were within the normal ranges for RA patients as compared to controls (p>0.05).

The levels of TAT, F1+2 and DD were highly significantly elevated in RA patients as compared to the controls (p<0.001).

There were positive correlations between TAT, F1+2 and DD to each other (p<0.001, r=0.743, r=0.680 and r=0.615) respectively.

By calculating the MGDA; our RA patients were all in active state; 5 patients (20.8%) as grade II, 9 patients (37.5%) as grade III and 10 patients (41.6%) as grade IV.

There were positive relations between MGDA and evaluated CAMs; TAT, F1+2 and DD for RA patients (p<0.001).

While there were positive significant relations (p<0.05) between them and only four individual parameters of this score; morning stiffness (MS), joint tenderness (JT), severity of pain (SP) and ESR.

As regards the assessment of functional status, RA patients were divided into; 14 patients (58.3%) in grade II, 9 patients (37.5%) in grade III and 1 patient (4.2%) in grade IV.

There were positive relations between grades of functional status and estimated CAMs; TAT, F1+2 and DD (p<0.001).

Conclusion: Based on the previous results, there was close relation between raised CAMs, progression of RA and increasing functional disability.

So, RA patients with high risk tendency of developing coagulation phenomena, can be identified prior to the onset of overt thrombotic disease by estimation of CAMs mainly the level of TAT.