The diagnostic value of 14-3-3η protein levels in patients with rheumatoid arthritis

Evaluation of 14-3-3eta protein as a diagnostic biomarker in the initial assessment of inflammatory arthritis

Objective

Serum 14-3-3eta are novel biomarkers of rheumatoid arthritis (RA). It is not clear whether 14-3-3eta may be present in other forms of inflammatory arthritis (IA). We evaluated the presence of 14-3-3eta as a diagnostic biomarker in the evaluation IA.

Methods

A retrospective cohort study of adult patients who were evaluated for IA by a rheumatologist with a result for the lab test of 14-3-3eta was conducted.

Results

Of 280 included patients, 30% were diagnosed with RA, 11% with psoriatic arthritis (PsA), and 59% with another condition. Twenty-four (9%) patients had positive results for 14-3-3eta. Fifty-two percent of positive patients were diagnosed with RA, with 48% having another diagnosis including axial spondyloarthritis, gout, Sjögren's, undifferentiated IA, diabetic cheiroarthropathy, prostate cancer with bone metastasis, osteoarthritis, unspecified arthralgia. No patients with PsA had a positive value. RA patients had a higher value for 14-3-3eta compared to non-RA (5.44 [1.56~9.31] vs. 0.69 [0.40~0.98] ng/mL, p=0.03, square brackets are 95% confidence interval values). The mean value for the 14-3-3eta in seropositive RA trended higher than seronegative (8.0 [2.3~13.7] vs. 1.4 [0.4~2.4] ng/mL, p=0.06). In the RA cohort, elevated 14-3-3eta was associated with elevated erythrocyte sedimentation rate (odd ratio=6.62 [1.24~47.09], p<0.04), but not other variables.

Conclusion

14-3-3eta may aid as a diagnostic biomarker of RA. However, it is not specific for RA, especially at low positive levels, and may be positive in other forms of IA. Ideal cutoff values need to be established for RA and non-RA conditions. It was not found in PsA.

14-3-3 Eta protein as a novel biomarker in early detection of uveitis in Egyptian juvenile idiopathic arthritis and rheumatoid arthritis patients: Diagnostic and prognostic value

Background and Objectives

Juvenile Idiopathic Arthritis (JIA) and Rheumatoid arthritis (RA) are autoimmune chronic inflammatory disorders of undetermined cause. Uveitis is one of the commonest and most dangerous extra-articular manifestations of JIA and RA presenting chronic anterior uveitis with non-specific biomarkers for its early detection. We evaluated the role of serum 14-3-3 Eta protein to assess its potential role as a novel biomarker for the early detection of uveitis in Egyptian JIA and RA patients as well as its correlation with disease activity.

Methods

A case-control study included three patient groups: group I includes 42 JIA patients, group II includes 42 RA patients, and an equal number of apparently healthy individuals matched in sex and age for each group of patients as controls, recruited from the rheumatology outpatient clinic. All participants were subjected to clinical examination, laboratory investigations with assessment of serum levels of 14-3-3 Eta protein, and ophthalmologic investigations to assess disease activity, eye affection, and its relation to 14-3-3 Eta protein level, and other disease variables among those patients.

Results

a statistically significant difference was estimated between the two patients' groups and controls regarding 14-3-3 Eta protein level. 14-3-3 Eta protein has a significant positive correlation with disease activity in JIA and RA patients. Also, RA patients with clinical uveitis had higher levels of the 14-3-3 Eta protein, while there were no significant differences among JIA patients with or without uveitis.

Conclusion

14-3-3 Eta protein is a potential diagnostic biomarker in early detection of uveitis in RA patients, as it is higher in patients versus controls especially those with uveitis with a cut-off point 57.5, at which patients must have a thorough eye examination to receive early intervention and, to prevent complications, while it doesn't have the same role in JIA patients. 14-3-3 Eta protein is a potential diagnostic and prognostic marker for JIA and RA being correlated with disease activity.

Serum 14‑3‑3η levels are increased and associated with a higher risk of osteoporosis in patients with rheumatoid arthritis: A meta‑analysis

14-3-3η can regulate the cell cycle, immunity, inflammation and the secretion of matrix metalloproteinases, while it may also be involved in the development of rheumatoid arthritis (RA) and promote bone injury. Therefore, the present meta-analysis focused on the dysregulated serum levels of 14-3-3η and its association with osteoporosis in patients with RA. Studies comparing the serum levels of 14-3-3η between patients with RA and healthy controls (HCs) or patients with RA with different bone mineral densities were retrieved from the EMBASE, Web of Science, PubMed and Cochrane databases. A total of 14 studies comprising 2,164 patients with RA and 1,136 HCs were included and analysed. Pooled analyses showed that the serum levels of 14-3-3η were enhanced in patients with RA compared with HCs [standardized mean difference (SMD): 1.34; 95% confidence interval (CI): 1.01-1.66; P<0.001]. In addition, the serum levels of 14-3-3η were also significantly higher in patients with RA with osteoporosis and osteopenia compared with those with normal bone mass (SMD: 1.96; 95% CI: 0.01-3.92; P=0.049 and SMD: 0.80; 95% CI: 0.09-1.52; P=0.028, respectively). Begg's and Egger's tests demonstrated that the publication bias for each evaluated indicator was low (all P>0.05). However, sensitivity analyses revealed that the findings were not very robust, which may be due to the omission of several individual studies. Overall, the present meta-analysis suggested that the serum levels of 14-3-3η were elevated and were associated with a higher risk of osteoporosis in patients with RA, thus supporting its potency as a circulating biomarker in the management of RA.

Biomarkers in Rheumatoid Arthritis

The utilization and identification of biomarkers in rheumatoid arthritis (RA) to facilitate timely diagnosis and the optimal management of the disease is an area of active investigation. This review focuses on biomarkers available for routine clinical use, details potential investigational biomarkers, and raises outstanding clinical questions.

Serum 14-3-3η is a Marker that Complements Current Biomarkers for the Diagnosis of RA: Evidence from a Meta-analysis

OBJECTIVE

To systematically evaluate the diagnostic value of 14-3-3η protein for rheumatoid arthritis (RA).

METHOD

Searched PubMed, Web of Science, Embase and China Biology Medicine (CBM) databases comprehensively from inception to May 2020. The evaluation index were the pooled sensitivity, specificity, diagnosis odds ratio (DOR), positive likelihood ratio (PLR), negative likelihood ratio (NLR), as well as the area under the summary receiver operating characteristic (SROC) curves. Meta-Disc 1.4 and RevMan 5.3 were used to analyze all statistics. QUADAS-2 tool was applied to evaluate the quality of eligible studies. Subgroup analysis and meta-regression were used to explore the sources of heterogeneity.

RESULTS

Nine articles containing eleven records were eligible for this meta-analysis. The pooled sensitivity of 14-3-3η was 0.63 (95% CI: 0.60 to 0.66), the pooled specificity was 0.90 (95% CI: 0.88 to 0.91). The pooled PLR and NLR was 6.10 (95% CI: 4.67 to 7.96) and 0.40 (95% CI: 0.33 to 0.48), respectively. The pooled DOR was 15.90 (95% CI: 11.15 to 22.68), and the area under the curve (AUC) was 0.8696. Compared with a single indicator (rheumatoid factor or anti-citrullinated protein antibodies), adding 14-3-3η can bring incremental benefits to the diagnosis of RA. The results of subgroup analysis and meta-regression suggested that the two factors (ethnicity, early vs established RA) we analyzed might not be the source of heterogeneity (P value were 0.0979 and 0.4298, respectively) and there was no publication bias among these articles (P = .42).

CONCLUSION

Serum 14-3-3η protein is a supplementary biomarker in the diagnosis of RA.

Diagnostic accuracy of 14-3-3 η protein in rheumatoid arthritis: A meta-analysis

AIM

To evaluate the overall diagnostic performance of 14-3-3 η protein in patients with rheumatoid arthritis (RA).

METHODS

PubMed, EMBASE, and Web of Science were searched to acquire eligible studies. Articles published in English before 20 February 2020 were included. Quality Assessment of Diagnostic Accuracy Studies 2 was used to evaluate the risk of bias and application concern of the included articles. Pooled analysis of diagnostic indicators of 14-3-3 η protein for RA was conducted by using a random effects model. Subgroup analysis was used to explore the sources of heterogeneity. Deeks' funnel plot asymmetry test was used to evaluate for the presence of publication bias.

RESULTS

A total of 13 studies (1554 positive and 1934 negative participants) were included. The pooled sensitivity and specificity were 0.73 (95% CI 0.71-0.75) and 0.88 (95% CI 0.87-0.90), respectively. The pooled positive/negative likelihood were 5.98 (95% CI 4.39-8.14) and 0.28 (95% CI 0.21-0.37), respectively. In addition, the pooled diagnostic odds ratio was 23.48 (95% CI 13.76-40.08) and the area under curve was 0.9245. The results of subgroup analysis indicated that ethnicity and control group might be the source of heterogeneity. The results of sensitivity analysis were stable. No significant publication bias was found.

CONCLUSIONS

The current evidence indicated that 14-3-3 η protein has moderate accuracy for the diagnosis of RA.

The association among 14-3-3η protein, inflammation, bone remodeling and osteoporosis in patients with rheumatoid arthritis

Objective:

To evaluate the correlation among 14-3-3η protein, inflammation, bone remodeling and osteoporosis in patients with rheumatoid arthritis.

Methods:

In this cross-sectional study, the RA patients treated in our hospital were analyzed between January 2015 and November 2019. Bone mineral density was measured using dual energy X-ray absorptiometry, and at the beginning of the study, serum samples were collected and the level of 14-3-3η, TNF-α, and IL-6 was tested using the quantitative enzyme-linked immunosorbent assay, and I-CTX and PINP were measured using automatic electrochemical luminescence immune-analyzer for all the participants.

Results:

In the current study, 285 patients with rheumatoid arthritis were enrolled and assigned into normal, osteopenia, and osteoporotic group respectively. The level of 14-3-3η and IL-6 presented with the highest value in the osteoporosis group, but the lowest value in the normal group, and there were significant differences in the level of 14-3-3η and IL-6 among the groups (p<0.05), and there was positive correlation between 14-3-3η and IL-6 (p<0.05). There were significant differences in PINP and I-CTX among the three groups (p<0.05), and a significantly positive correlation between I-CTX and 14-3-3η (p<0.05) and a significantly negative correlation between PINP and 14-3-3η (p<0.05) were found.

Conclusion:

There was a significant correlation among 14-3-3η protein, inflammation, bone remodeling and osteoporosis in patients with rheumatoid arthritis, the influence of 14-3-3η on osteoporosis may be contributed to its adjusting inflammation and bone remodeling.

Clinical diagnostic significance of 14-3-3η protein, high-mobility group box-1, anti-cyclic citrullinated peptide antibodies, anti-mutated citrullinated vimentin antibodies and rheumatoid factor in rheumatoid arthritis

Introduction: Circulating markers of rheumatoid arthritis (RA) include the 14-3-3η protein, high-mobility group box-1 (HMGB1), anti-cyclic citrullinated peptide (anti-CCP) antibodies, anti-mutated citrullinated vimentin (anti-MCV) antibodies and rheumatoid factor (RF). We set out to determine which two markers in combination provided best discriminatory power for this disease.Methods: We recruited 108 RA patients, 102 non-RA patients (SLE, AS, Sjogren's syndrome, MCTD) and 90 healthy controls. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and the Youden index of each analyte were calculated and binary logistic regression analysis and receiver operating characteristic (ROC) curve were performed to evaluate their diagnostic value for RA alone and in paired combination.Results: As expected, all markers were elevated in RA patients (P < 0.05). Binary logistic regression analysis showed that 14-3-3η had the highest odds ratio (95% CI) at 2.4 (1.9-2.8). Anti-CCP and anti-MCV had the highest areas under the curves [AUC (95% CI)] at 0.85 (0.78-0.90) and 0.85 (0.78-0.91) respectively (both P < 0.001). In serial detection (one marker followed by another), no combination had a Youden index >0.6. In parallel analysis (both considered together) several combinations had a Youden index >0.7, of which the highest (0.78) was anti-CCP with anti-MCV, with a sensitivity of 93.3% and specificity of 84.7%.Conclusions: Despite individual increases in serum 14-3-3η, HMGB1, anti-CCP, anti-MCV and RF, the combination of anti-CCP and anti-MCV might be of great help for diagnostic in RA, and so should be considered as routine tests for this disease.