Comprehensive Assessment of Immunological (Anti-CCP, TNF-α, and ADA) and Biochemical (ESR and CRP) Biomarkers in Correlation with Disease Activity Scores in Rheumatoid Arthritis Patients from Kirkuk City

Abstract

Rheumatoid arthritis (RA) is a persistent autoimmune disorder marked by joint inflammation and permanent damage. This study examined the clinical relevance of immunological, biochemical, and demographic biomarkers—Anti-Cyclic Citrullinated Peptide (anti-CCP), Tumor Necrosis Factor-alpha (TNF-α), Adenosine Deaminase (ADA), Erythrocyte Sedimentation Rate (ESR), C-reactive Protein (CRP), and Gender—in connection with disease activity evaluated by the Disease Activity Score 28 (DAS28). This case-control study, conducted in Kirkuk City, Iraq, comprised 90 rheumatoid arthritis patients categorized into untreated and treated groups, alongside 45 healthy controls matched for age and gender. The results indicated substantial post-treatment decreases in anti-CCP, TNF-α, ADA, ESR, and CRP levels, signifying therapeutic efficacy. Notwithstanding clinical advancements, anti-CCP and TNF-α levels continued to be higher relative to controls, reflecting ongoing autoimmune activity. ADA normalized post-treatment, indicating restored T-cell functionality. ESR and CRP shown strong responses to treatment, corresponding effectively with clinical results. Gender analysis indicated substantial disparities in biomarker profiles, highlighting hormonal influences on illness development. association tests revealed a robust negative association between pre-treatment TNF-α and DAS28 (r = -0.729, p < 0.001), which dissipated post-treatment, while anti-CCP exhibited a moderate correlation post-treatment (r = -0.454, p < 0.001). ADA demonstrated a low association, signifying its negligible contribution to the evaluation of joint-specific activity. These findings confirm the critical importance of these biomarkers in assessing disease activity, determining treatment effectiveness, and customizing personalized RA management approaches. Consistent assessment of these markers may enhance clinical results in rheumatoid arthritis patients.