K C
I.£. - Ù‡¯Ô˜ 57
∏ Û˘Ì‚ÔÏ‹ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛˆÓ
ÛÙË ‰È¿ÁÓˆÛË Î·È ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂ-
ÙÒÈÛË Ù˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·ÚıÚ›Ùȉ·˜
1. ∂π™∞°ø°H
∏ ÚÂ˘Ì·ÙÔÂȉ‹˜ ·ÚıÚ›Ùȉ· Â›Ó·È ÓfiÛÔ˜ ·ÁÓÒ-
ÛÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜ ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ÔÔ›-
·˜ Û˘ÌÌÂÙ¤¯ÂÈ Ë ·˘ÙÔ·ÓÔÛ›·. ∂›Ó·È ¯ÚfiÓÈ· ÓfiÛÔ˜
Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·
Î·È ÌÔÚ› Ó· ηٷϋÍÂÈ Û ·Ó·ËÚ›·. ¶ÚÔÛ‚¿Ï-
ÏÂÈ ÙȘ Á˘Ó·›Î˜ Û˘¯ÓfiÙÂÚ· ·fi ÙÔ˘˜ ¿Ó‰Ú˜ ÛÂ
·Ó·ÏÔÁ›· 3/1. ™ÙȘ Á˘Ó·›Î˜ ·Ú·ÙËÚÂ›Ù·È Û˘¯Ó¿
ÛÙËÓ ·ÒÙÂÚË ·Ó··Ú·ÁˆÁÈ΋ ËÏÈΛ· Î·È ÛÙÔ˘˜
¿Ó‰Ú˜ ÙËÓ 6Ë Ò˜ 8Ë ‰ÂηÂÙ›·, fiϘ ˆÛÙfiÛÔ ÔÈ Ë-
ÏÈ˘ ÌÔÚ› Ó· ÚÔÛ‚ÏËıÔ‡Ó. ∏ ÓfiÛÔ˜ ÚÔ-
Û‚¿ÏÏÂÈ Î˘Ú›ˆ˜ ÙȘ ÌÈÎÚ¤˜ Î·È ÌÂÁ¿Ï˜ ·ÚıÚÒ-
ÛÂȘ, ·ÏÏ¿ ¤¯ÂÈ ÂΉËÏÒÛÂȘ ·fi fiÏ· Ù· Û˘ÛÙ‹Ì·-
Ù· ÔÚÁ¿ÓˆÓ. ™‹ÌÂÚ· Û˘˙ËÙÂ›Ù·È ¤ÓÙÔÓ· Ë Â›‰Ú·-
ÛË Ù˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·ÚıÚ›Ùȉ·˜ ÛÙËÓ Î·Ú‰È·Á-
ÁÂȷ΋ ÓÔÛËÚfiÙËÙ·, ηıÒ˜ Ë ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ‹
Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ ÙË ÓfiÛÔ ÌÔÚ› Ó· ¤¯ÂÈ ˆ˜ ·-
ÔÙ¤ÏÂÛÌ· ÙËÓ ÚÒÈÌË ÂÌÊ¿ÓÈÛË ·ıËÚÔÛÎÏ‹Ú˘Ó-
Û˘ Î·È ÙÂÏÈο Ó· ÂËÚ¿˙ÂÈ ÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ·-
ÛıÂÓÒÓ Ô˘ ¿Û¯Ô˘Ó ·fi ÙË ÓfiÛÔ.
Δ· Û˘ÌÙÒÌ·Ù· ÁÂÓÈο ·Ú¯›˙Ô˘Ó ·fi ÙȘ ÂÁ-
Á‡˜ ÌÂÛÔÊ·Ï·ÁÁÈΤ˜, ÙȘ ÌÂٷηÚÔÊ·Ï·ÁÁÈΤ˜
Î·È ÌÂٷٷÚÛÔÊ·Ï·ÁÁÈΤ˜ ·ÚıÚÒÛÂȘ. ¶ÚÔÛ‚¿Ï-
ÏÔÓÙ·È ÔÈ ·ÚıÚÒÛÂȘ ηÚÒÓ, ‰·ÎهψÓ, ÁÔÓ¿-
ÙˆÓ Î·È ¿ÎÚˆÓ Ô‰ÒÓ. ∏ ·ÚıÚÈ΋ ÚÔÛ‚ÔÏ‹ ›ӷÈ
Û˘ÌÌÂÙÚÈ΋. ∏ ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ
ÙËÓ ÚÔÛ‚ÔÏ‹ ÌÂÁ·Ï˘Ù¤ÚˆÓ ·ÚıÚÒÛˆÓ, fiˆ˜
ÔÈ ÒÌÔÈ, ÔÈ ·ÁÎÒÓ˜ Î·È Ù· ÁfiÓ·Ù·. ¶·Ú·ÙËÚ›ٷÈ
Û˘ÌÌÂÙÚÈÎfi Ô›‰ËÌ· ÙˆÓ ÌÂٷηÚÔÊ·Ï·ÁÁÈÎÒÓ
Î·È ÂÁÁ‡˜ ÌÂÛÔÊ·Ï·ÁÁÈÎÒÓ ·ÚıÚÒÛˆÓ. ªÔÚ›
25
K C
K
∏ π·ÙÚÈ΋ ™‹ÌÂÚ·
¶·Ó·ÁÈÒÙ˘ ∞ı·Ó·Û›Ô˘1,
πÊÈÁ¤ÓÂÈ· ∫ÒÛÙÔÁÏÔ˘-∞ı·Ó·Û›Ô˘2
1¢È‰¿ÎÙˆÚ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,
¢È¢ı˘ÓÙ‹˜ ƒÂ˘Ì·ÙÔÏÔÁÈÎÔ‡ ΔÌ‹Ì·ÙÔ˜,
°.¡. £ÂÛÛ·ÏÔӛ΢ «ÕÁÈÔ˜ ¶·‡ÏÔ˜»
2¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,
¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›Ô˘ §ÔÓ‰›ÓÔ˘,
∂ÈÌÂÏ‹ÙÚÈ· ∞′ ∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎÔ‡ ΔÌ‹Ì·ÙÔ˜,
°.¡. ∞ıËÓÒÓ «∫ÔÚÁȷϤÓÂÈÔ-ªÂÓ¿ÎÂÈÔ» ∂.∂.™.
Ó· ·Ú·ÙËÚËı› Î·È ÚÔÛ‚ÔÏ‹ ÙˆÓ ¿ˆ ÌÂÛÔÊ·-
Ï·ÁÁÈÎÒÓ ·ÚıÚÒÛˆÓ. ∏ ÚÔÛ‚ÔÏ‹ ÙˆÓ ÌÂÙ·-
ηÚÔÊ·Ï·ÁÁÈÎÒÓ ·ÚıÚÒÛÂˆÓ ÌÔÚ› Ó· Û˘ÓÔ-
‰Â‡ÂÙ·È ·fi ˘ÂÍ¿ÚıÚËÌ· Î·È ˆÏ¤ÓÈ· ·fiÎÏÈÛË.
∏ ÚÔÛ‚ÔÏ‹ ÙˆÓ ÌÂÛÔÊ·Ï·ÁÁÈÎÒÓ ·ÚıÚÒÛˆÓ
ÌÔÚ› Ó· Ô‰ËÁ› Û ·Ú·ÌfiÚʈÛË ‰›ÎËÓ Ï·ÈÌÔ‡
·ÎÓÔ˘, ‰›ÎËÓ ÎÔÌ‚ÈÔ‰fi¯Ô˘ Î·È Û ·ÛÙ·ı‹ ÂÁÁ‡˜
ÌÂÛÔÊ·Ï·ÁÁÈ΋ ¿ÚıÚˆÛË.
∏ ÔÚ›· Ù˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·ÚıÚ›Ùȉ·˜
ÌÔÚ› Ó· Â›Ó·È Û‡ÓÙÔÌË ‹ Ì·ÎÚ¿ Î·È ÚÔԉ¢ÙÈ-
΋ ‹ ÂӉȿÌÂÛË1. ∏ ‚·Ú‡ÙËÙ· Ù˘ ÚÂ˘Ì·ÙÔÂȉԇ˜
ÌÔÚ› Â›Û˘ Ó· ÔÈΛÏÏÂÈ. OÈ ÚÔÛ‚ÔϤ˜ Ù˘
ÓfiÛÔ˘ ÌÔÚ› Ó· Â›Ó·È Ì·ÎÚ¤˜ Î·È ‹Ș ‹ Ì·ÎÚ¤˜
Î·È ÚÔԉ¢ÙÈο ·˘Í·ÓfiÌÂÓ˘ ‚·Ú‡ÙËÙ·˜. ¢Â›-
ÎÙ˜ η΋˜ ÚfiÁÓˆÛ˘ Ù˘ ÓfiÛÔ˘ Â›Ó·È Ë ·˘ÍË-
̤ÓË Ù·¯‡ÙËÙ· ηı›˙ËÛ˘ ÙˆÓ ÂÚ˘ıÚÒÓ, Ë ·˘ÍË-
̤ÓË C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË, Ë ‡·ÚÍË ÚÂ˘Ì·ÙÔ-
ÂȉÒÓ Ô˙ȉ›ˆÓ, Ë ‡·ÚÍË Â͈·ÚıÚÈÎÒÓ ÂΉËÏÒ-
ÛˆÓ, Ô ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÚÔۂ‚ÏËÌ¤ÓˆÓ ·Ú-
ıÚÒÛÂˆÓ Î·È Ë ÁÚ‹ÁÔÚË ÂÌÊ¿ÓÈÛË ·ÚıÚÈÎÒÓ ‰È·-
‚ÚÒÛˆÓ.
2. ¢πA°¡ø™∏
∏ ‰È¿ÁÓˆÛË Ù˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·ÚıÚ›Ùȉ·˜
Á›ÓÂÙ·È Ì ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ ∞ÌÂÚÈηÓÈÎÔ‡
∫ÔÏÏÂÁ›Ô˘ ƒÂ˘Ì·ÙÔÏÔÁ›·˜2-4. ™Ù· ‰È·ÁÓˆÛÙÈο
ÎÚÈÙ‹ÚÈ· Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ÚˆÈÓ‹ ‰˘ÛηÌ-
„›·, Ë ·ÚıÚ›Ùȉ· Û 3 ÂÚÈÔ¯¤˜, Ë ·ÚıÚ›Ùȉ· ¯ÂÈ-
ÚÒÓ, Ë Û˘ÌÌÂÙÚÈ΋ ·ÚıÚ›Ùȉ·, Ë ·ÚÔ˘Û›· Ú¢-
Ì·ÙÔÂȉÒÓ Ô˙ȉ›ˆÓ, Ë ·ÚÔ˘Û›· ÙÔ˘ ÚÂ˘Ì·ÙÔÂÈ-
K
K C
∏ π·ÙÚÈ΋ ™‹ÌÂÚ·
‰Ô‡˜ ·Ú¿ÁÔÓÙ· ÛÙÔÓ ÔÚfi ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Ë ‡-
·ÚÍË ·ÎÙÈÓÔÏÔÁÈÎÒÓ ·ÏÏÔÈÒÛˆÓ. ªÔÚ› Ó·
·Ú·ÙËÚÂ›Ù·È ÎfiˆÛË, ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ‹ ˘ÚÂ-
Ùfi˜ Î·È fiÓÔ˜ ‹/Î·È Ô›‰ËÌ· ÙˆÓ ·ÚıÚÒÛˆÓ. °È·
Ó· ÙÂı› Ë ‰È¿ÁÓˆÛË Ù˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·ÚıÚ›ÙÈ-
‰·˜ Ù· Û˘ÌÙÒÌ·Ù· Ú¤ÂÈ Ó· ˘¿Ú¯Ô˘Ó ÁÈ· 6 Â-
‚‰ÔÌ¿‰Â˜.
3. ∂ƒ°∞™Δ∏ƒπ∞∫A ∂ÀƒHª∞Δ∞
3.1. °ÂÓÈο
¶·Ú·ÙËÚÂ›Ù·È ·Ó·ÈÌ›·, ·˘ÍË̤ÓË Ù·¯‡ÙËÙ·
ηı›˙ËÛ˘ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ηÈ/‹ ·˘ÍË̤-
ÓË C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË. ÷ڷÎÙËÚÈÛÙÈÎfi ÂÚÁ·-
ÛÙËÚÈ·Îfi ‡ÚËÌ· ÛÙË ÚÂ˘Ì·ÙÔÂȉ‹ ·ÚıÚ›Ùȉ· ›-
Ó·È Ë ıÚÔÌ‚Ô΢ÙÙ¿ÚˆÛË. ªÔÚ› Ó· ·Ú·ÙËÚ›-
Ù·È ıÂÙÈÎfi˜ ÚÂ˘Ì·ÙÔÂȉ‹˜ ·Ú¿ÁÔÓÙ·˜ Û ÔÛÔ-
ÛÙfi 60% Ò˜ 80%. ∞ÓÙÈ˘ÚËÓÈο ·ÓÙÈÛÒÌ·Ù· ·ÓÈ-
¯Ó‡ÔÓÙ·È Û ÔÛÔÛÙfi 30%. ∞ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ
ÎÈÙÚÔ˘ÏÏÈÓÈˆÌ¤ÓˆÓ ÂÙȉ›ˆÓ (·ÓÙÈ-CCP) ÌÔÚ›
Ó· ·ÓȯÓ‡ÔÓÙ·È Û ÔÛÔÛÙfi 80% ÂÓÒ ·ÓÙÈÔ˘‰ÂÙÂ-
ÚÔÊÈÏÈο ΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈο ·ÓÙÈÛÒÌ·Ù· (ANCA)
ÛÂ ÔÛÔÛÙfi 30%.
∏ ÂͤٷÛË ·ÚıÚÈÎÔ‡ ˘ÁÚÔ‡ ‰ÂÓ ‰Â›¯ÓÂÈ ·ıÔ-
ÁÓˆÌÔÓÈο Â˘Ú‹Ì·Ù·. ªÔÚ› Ó· ˘¿Ú¯ÂÈ Ï¢ÎÔ-
΢ÙÙ¿ÚˆÛË Ì ·ÚÈıÌfi Ï¢ÎÒÓ ÛÙÔ ·ÚıÚÈÎfi ˘ÁÚfi
·fi 5.000-50.000/Ìl, ÂÎ ÙˆÓ ÔÔ›ˆÓ Ù· 2/3 ›ӷÈ
Ô˘‰ÂÙÂÚfiÊÈÏ·.
3.2. ƒÂ˘Ì·ÙÔÂȉ›˜ ·Ú¿ÁÔÓÙ˜
OÈ ÚÂ˘Ì·ÙÔÂȉ›˜ ·Ú¿ÁÔÓÙ˜ Â›Ó·È ·ÓÙÈÛÒÌ·-
Ù·, IgM Î·È Û·ÓÈfiÙÂÚ· IgG ‹ IgA Ô˘ ÛÙÚ¤ÊÔÓÙ·È
ηٿ ÂÈÙfiˆÓ ÙÔ˘ Fc ÙÌ‹Ì·ÙÔ˜ Ù˘ IgG ·ÓÔÛÔ-
ÛÊ·ÈÚ›Ó˘. ™ÙË ÚÂ˘Ì·ÙÔÂȉ‹ ·ÚıÚ›Ùȉ· Ë ·ÚÔ˘-
Û›· ÚÂ˘Ì·ÙÔÂȉԇ˜ ·Ú¿ÁÔÓÙ· Û¯ÂÙ›˙ÂÙ·È ÈÛ¯˘Ú¿
Ì ‚·ÚÈ¿ ·ÚıÚÈ΋ ÓfiÛÔ Î·È Â͈·ÚıÚÈο Û˘ÌÙÒ-
Ì·Ù·. øÛÙfiÛÔ, ÚÂ˘Ì·ÙÔÂȉ›˜ ·Ú¿ÁÔÓÙ˜ ‰ÂÓ ·-
ÓȯÓ‡ÔÓÙ·È ÌfiÓÔ ÛÙË ÚÂ˘Ì·ÙÔÂȉ‹ ·ÚıÚ›Ùȉ·.
∞ÓȯÓ‡ÔÓÙ·È Î·È Û ¿ÏϘ ÓfiÛÔ˘˜ Ì ¯ÚfiÓÈ· ‰È¤-
ÁÂÚÛË ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.
ƒÂ˘Ì·ÙÔÂȉ‹˜ ·Ú¿ÁÔÓÙ·˜ ÌÔÚ› Ó· ·ÓÈ-
¯Ó‡ÂÙ·È ÂÎÙfi˜ ·fi ÙË ÚÂ˘Ì·ÙÔÂȉ‹ ·ÚıÚ›Ùȉ·,
ÛÙÔ Û‡Ó‰ÚÔÌÔ Sjogren’s, ÛÙÔÓ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘-
ıËÌ·ÙÒ‰Ë Ï‡ÎÔ Î·È Û ¿ÏÏ· ÚÂ˘Ì·ÙÈο ÓÔÛ‹Ì·-
Ù·. ƒÂ˘Ì·ÙÔÂȉ‹˜ ·Ú¿ÁÔÓÙ·˜ ÌÔÚ› Â›Û˘ Ó·
·ÓȯÓ‡ÂÙ·È Û ÏÔÈÌÒÍÂȘ fiˆ˜ Ë ÈÔÁÂÓ‹˜ Ë·Ù›-
Ùȉ·, ÂȉÈÎfiÙÂÚ· Ë Ë·Ù›Ùȉ· C, Ë Ïԛ̈ÍË ·fi
ÙÔÓ Èfi Epstein Barr, Ë Ïԛ̈ÍË ·fi ÙÔÓ Èfi Parvo
Î·È Ë ÁÚ›Ë. ƒÂ˘Ì·ÙÔÂȉ‹˜ ·Ú¿ÁÔÓÙ·˜ ÌÔÚ›
Ó· ·ÓȯÓ‡ÂÙ·È Î·È Û ‚·ÎÙËÚȷΤ˜ ÏÔÈÌÒÍÂȘ fi-
ˆ˜ Ë ÂÓ‰Ôηډ›Ùȉ·, Ë ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· Î·È ¿Ï-
26
K C
K
Ϙ. ƒÂ˘Ì·ÙÔÂȉ‹˜ ·Ú¿ÁÔÓÙ·˜ ÌÔÚ› Ó· ·ÓÈ-
¯Ó‡ÂÙ·È ·ÎfiÌ· Û Ë·ÙÈ΋ ÓfiÛÔ, Û ÊÏÂÁÌÔÓÒ-
‰Ë ÓfiÛÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È Û ¿ÏϘ ÊÏÂÁÌÔÓÒ‰ÂȘ
ηٷÛÙ¿ÛÂȘ Î·È ÛÙÔ Á‹Ú·˜.
3.3. ∞ÓÙÈ-CCP ·ÓÙÈÛÒÌ·Ù·
∏ ·Ó›¯Ó¢ÛË ÙˆÓ ·ÓÙÈ-CCP ·ÓÙÈۈ̿وÓ
(anticyclic citrullinated peptide antibodies) ·ÔÙ¤-
ÏÂÛ ÂͤÏÈÍË ÛÙËÓ ÂÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË Î·È
ÙÂÎÌËÚ›ˆÛË Ù˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·ÚıÚ›Ùȉ·˜. Δ·
·ÓÙÈÛÒÌ·Ù· ·˘Ù¿ Â›Ó·È ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÌÔ-
Ú›ˆÓ ÎÈÙÚÔ˘ÏÏ›Ó˘ Î·È ¤¯Ô˘Ó ηϋ ÂȉÈÎfiÙËÙ· ÁÈ·
ÙË ÚÂ˘Ì·ÙÔÂȉ‹ ·ÚıÚ›Ùȉ·. ∏ ÎÈÙÚÔ˘ÏÏ›ÓË Û¯ËÌ·-
Ù›˙ÂÙ·È ·fi ÌÂÙ·-ÌÂÙ·ÊÚ·ÛÙÈ΋ ÙÚÔÔÔ›ËÛË ÚÈ-
˙ÒÓ ·ÚÁÈÓ›Ó˘ Ì ٷ ¤Ó˙˘Ì· ·Ô-ÈÌÈÓ¿Û˜ ÂÙÈ-
‰˘Ï-·ÚÁÈÓ›Ó˘. Δ¤ÙÔÈ· ÎÈÙÚÔ˘ÏÏÈÓȈ̤ӷ ÌfiÚÈ· ›-
Ó·È Ë ÊÈÏ·ÁÎÚ›ÓË, Ë ÎÂÚ·Ù›ÓË, Ë ÊÈÌÚ›ÓË Î·È Ë ‚È-
ÌÂÓÙ›ÓË. ™‹ÌÂÚ· Ù· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÎÈÙÚÔ˘ÏÏÈ-
ÓÈˆÌ¤ÓˆÓ ÌÔÚ›ˆÓ ·ÓȯÓ‡ÔÓÙ·È Ì ·ÓÔÛÔ-ÂÓ˙˘ÌÈ΋
̤ıÔ‰Ô (ELISA) ηٿ ÙËÓ ÔÔ›· ¯ÚËÛÈÌÔÔÈ›ٷÈ
ˆ˜ ·ÓÙÈÁfiÓÔ Î˘ÎÏÈÎfi ÎÈÙÚÔ˘ÏÏÈÓȈ̤ÓÔ ÂÙ›‰ÈÔ.
OÈ Â›ÙÔÔÈ ÙˆÓ ·ÓÙÈÁfiÓˆÓ Ô˘ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È
·fi Ù· ·ÓÙÈÛÒÌ·Ù· ·˘Ù¿ Â›Ó·È Ú›˙˜ ·ÚÁÈÓ›Ó˘.
∞˘Ù¤˜ ÎÈÙÚÔ˘ÏÏÈÓÈÒÓÔÓÙ·È ·fi ¤Ó· ¤Ó˙˘ÌÔ Û ÎÈ-
ÙÚÔ˘ÏÏ›ÓË, Ô˘ Â›Ó·È ¤Ó· ·ÌÈÓÔ͇. OÈ ÎÈÙÚÔ˘ÏÏÈ-
ÓȈ̤ÓÔÈ Â›ÙÔÔÈ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Î·È ·fi ¿ÏÏ·
·ÓÙÈÛÒÌ·Ù· Û¯ÂÙÈ˙fiÌÂÓ· Ì ÙË ÚÂ˘Ì·ÙÔÂȉ‹ ·Ú-
ıÚ›Ùȉ·.
Δ· ·ÓÙÈ-CCP ·ÓÙÈÛÒÌ·Ù· ·ÓȯÓ‡ÔÓÙ·È Û Â-
Ú›Ô˘ 80% ÙˆÓ ·ÛıÂÓÒÓ. Δ· ·ÓÙÈ-CCP1 Î·È ·ÓÙÈ-
CCP2 ·ÓÙÈÛÒÌ·Ù· ¤¯Ô˘Ó ÌÂÁ¿ÏË ÂȉÈÎfiÙËÙ· ÁÈ·
ÙË ÚÂ˘Ì·ÙÔÂȉ‹ ·ÚıÚ›Ùȉ· Î·È Û¯ÂÙ›˙ÔÓÙ·È ÌÂ
‚Ï¿‚Ë ÙˆÓ ·ÚıÚÒÛˆÓ. ∏ ¢·ÈÛıËÛ›· ÙÔ˘˜ Î·È Ë
ÂȉÈÎfiÙËÙ¿ ÙÔ˘˜ ÁÈ· ÙË ÚÂ˘Ì·ÙÔÂȉ‹ ·ÚıÚ›Ùȉ· ›-
Ó·È 64%-74% Î·È 90%-99%, ·ÓÙ›ÛÙÔȯ·. O ÂÈÔ-
Ï·ÛÌfi˜ ÙˆÓ ·ÓÙÈ-CCP ·ÓÙÈÛˆÌ¿ÙˆÓ ‰È·Ê¤ÚÂÈ ÛÂ
‰È·ÊÔÚÂÙÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ ·ÛıÂÓÒÓ. O ‰È¿ÊÔ-
ÚÔ˜ ÂÈÔÏ·ÛÌfi˜ ÙˆÓ ·ÓÙÈ-CCP Û ‰È·ÊÔÚÂÙÈ-
ÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ ·ÛıÂÓÒÓ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È
ÛÙËÓ ‡·ÚÍË ‰È·ÊÔÚÂÙÈÎÒÓ ˘ÔÔÌ¿‰ˆÓ ÙˆÓ ·ÓÙÈ-
CCP, ÛÙË Û¯¤ÛË Ô˘ ˘¿Ú¯ÂÈ ÌÂٷ͇ ÙˆÓ ÂÈ¤-
‰ˆÓ ÙˆÓ ·ÓÙÈ-CCP Ì ٷ ·ÏÏ‹ÏÈ· HLA, ηıÒ˜ ·˘-
Ù¿ Â›Ó·È ˘„ËÏfiÙÂÚ· Û ·ÛıÂÓ›˜ Ì ÙÔÓ ÎÔÈÓfi Â›-
ÙÔÔ HLA DRB1, Î·È ÛÙËÓ Â›‰Ú·ÛË Ù˘ ıÂÚ·›-
·˜ ÛÙ· Â›‰· ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ·˘ÙÒÓ.
™Â ÌÂÙ·-·Ó¿Ï˘ÛË ÂÍÂÙ¿ÛÙËΠ·Ó Ù· ·ÓÙÈ-CCP
·ÓÙÈÛÒÌ·Ù· ·Ó·ÁÓˆÚ›˙Ô˘Ó Ì ÌÂÁ·Ï‡ÙÂÚË ‰È·-
ÁÓˆÛÙÈ΋ ·ÎÚ›‚ÂÈ· ·ÛıÂÓ›˜ Ì ÚÂ˘Ì·ÙÔÂȉ‹ ·Ú-
ıÚ›Ùȉ· Î·È ÚԂϤÔ˘Ó Î·Ï‡ÙÂÚ· ÙËÓ ·ÎÙÈÓÔÏÔ-
ÁÈ΋ ÚfiÔ‰Ô Ù˘ ÓfiÛÔ˘ ·fi ÙÔÓ ÚÂ˘Ì·ÙÔÂȉ‹ ·-
K
K C
Ú¿ÁÔÓÙ·5. ∂ÍÂÙ¿ÛıËÎÂ Ë Â˘·ÈÛıËÛ›·, Ë ÂȉÈÎfiÙË-
Ù· Î·È Ë ıÂÙÈ΋ Î·È ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›·
·fi 37 ÌÂϤÙ˜ ·ÓÙÈ-CCP ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È 50
ÌÂϤÙ˜ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·Ú¿ÁÔÓÙ·. ∏ Û˘ÓÔÏÈ΋
¢·ÈÛıËÛ›·, ÂȉÈÎfiÙËÙ· Î·È ıÂÙÈ΋ Î·È ·ÚÓËÙÈ΋
ÚÔÁÓˆÛÙÈ΋ ·Í›· ÁÈ· Ù· ·ÓÙÈ-CCP ·ÓÙÈÛÒÌ·Ù·
‹Ù·Ó 67%, 95%, 12.46 Î·È 0.36, ·ÓÙ›ÛÙÔȯ·. °È·
ÙÔÓ IgM ÚÂ˘Ì·ÙÔÂȉ‹ ·Ú¿ÁÔÓÙ· Ë Â˘·ÈÛıËÛ›·,
ÂȉÈÎfiÙËÙ· Î·È ıÂÙÈ΋ Î·È ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋
·Í›· ‹Ù·Ó 69%, 85%, 4.86 Î·È 0.38. ∏ ıÂÙÈ΋ ηÈ
·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· ÙÔ˘ IgM ÚÂ˘Ì·ÙÔÂÈ-
‰Ô‡˜ ·Ú¿ÁÔÓÙ·, ÙÔ˘ IgG ÚÂ˘Ì·ÙÔÂȉԇ˜ ·Ú¿-
ÁÔÓÙ· Î·È ÙÔ˘ IgA ÚÂ˘Ì·ÙÔÂȉԇ˜ ·Ú¿ÁÔÓÙ· ‹-
Ù·Ó ·ÚfiÌÔÈ·. Δ· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÌÂÏÂÙÒÓ
·fi ·ÛıÂÓ›˜ Ì ÚÒÈÌË ÚÂ˘Ì·ÙÔÂȉ‹ ·ÚıÚ›Ùȉ·
‹Ù·Ó ·ÚfiÌÔÈ· Ì ·˘Ù¿ ÙˆÓ ¿ÏÏˆÓ ÌÂÏÂÙÒÓ. ™Â 3
·fi 4 ÌÂϤÙ˜ ‚Ú¤ıËΠfiÙÈ Ô Î›Ó‰˘ÓÔ˜ ·ÎÙÈÓÔÏÔ-
ÁÈ΋˜ ÚÔfi‰Ô˘ Ù˘ ÓfiÛÔ˘ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ˜ fi-
Ù·Ó Ù· ·ÓÙÈ-CCP ·ÓÙÈÛÒÌ·Ù· ‹Ù·Ó ıÂÙÈο ·fi fi,ÙÈ
fiÙ·Ó Ô IgM ÚÂ˘Ì·ÙÔÂȉ‹˜ ·Ú¿ÁÔÓÙ·˜. ∞fi ÙË
ÌÂÙ·-·Ó¿Ï˘ÛË ·˘Ù‹ Ê¿ÓËΠfiÙÈ Ù· ·ÓÙÈ-CCP ·ÓÙÈ-
ÛÒÌ·Ù· Â›Ó·È ÂȉÈÎfiÙÂÚ· ·fi ÙÔÓ ÚÂ˘Ì·ÙÔÂȉ‹
·Ú¿ÁÔÓÙ· ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ÚÂ˘Ì·ÙÔÂȉԇ˜
·ÚıÚ›Ùȉ·˜ Î·È ÌÔÚ› Ó· ÚԂϤÔ˘Ó Î·Ï‡ÙÂÚ·
ÙËÓ ÂÌÊ¿ÓÈÛË ‰È·‚ÚˆÙÈ΋˜ ÓfiÛÔ˘.
Δ· ·ÓÙÈ-CCP ·ÓÙÈÛÒÌ·Ù· ·Ú¿ÁÔÓÙ·È ÙÔÈο
ÛÙȘ ÊÏÂÁÌ·›ÓÔ˘Û˜ ·ÚıÚÒÛÂȘ Î·È ˘¿Ú¯Ô˘Ó
ÚÈÓ ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ù˘ ÚÂ˘Ì·-
ÙÔÂȉԇ˜ ·ÚıÚ›Ùȉ·˜6. ∂›Ó·È Û˘¯Ó¿ ıÂÙÈο ÓˆÚ›˜
ÛÙËÓ ÔÚ›· Ù˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·ÚıÚ›Ùȉ·˜ fiÙ·Ó
Ë ‰È¿ÁÓˆÛË ÌÔÚ› Ó· ÌËÓ Â›Ó·È ‚¤‚·ÈË. ∫·Ù’ ·-
ÓÙ›ıÂÛË ÚÔ˜ ÙÔÓ ÚÂ˘Ì·ÙÔÂȉ‹ ·Ú¿ÁÔÓÙ·, Ù· ·-
ÓÙÈ-CCP ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ Ë·Ù›Ùȉ· C. º·›-
ÓÂÙ·È, ÂÔ̤ӈ˜, fiÙÈ Ù· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÎÈ-
ÙÚÔ˘ÏÏÈÓÈˆÌ¤ÓˆÓ ÂÙȉ›ˆÓ —citrullinated pepti-
des— Â›Ó·È ÂȉÈÎÔ› ‰È·ÁÓˆÛÙÈÎÔ› ‰Â›ÎÙ˜ —hall-
marks— Ù˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·ÚıÚ›Ùȉ·˜7-10. ∂ÈϤ-
ÔÓ, Û¯ÂÙ›˙ÔÓÙ·È Ì ÂÓÂÚÁfiÙÂÚ˜ Î·È ÛÔ‚·ÚfiÙÂÚ˜
ÌÔÚʤ˜ Ù˘ ÓfiÛÔ˘.
∏ ¿ÓÔÛË ·fiÎÚÈÛË Û citrullinated ÂÈÙfiÔ˘˜
Ê·›ÓÂÙ·È fiÙÈ Û˘ÌÌÂÙ¤¯ÂÈ ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›·
Ù˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·ÚıÚ›Ùȉ·˜. ∂Ú¢ÓËÙÈο ‰Â-
‰Ô̤ӷ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë citrullination ÂÙȉ›ˆÓ
ÌÔÚ› Ó· ·˘Í¿ÓÂÈ ÙË ÛÙ·ıÂÚfiÙËÙ· ÙÔ˘ Û˘ÌϤÁ-
Ì·ÙÔ˜ ÂÙȉ›ˆÓ ÙÔ˘ HLA-DRB1*0401 MHC Ù¿-
͢ ππ Î·È Ì ÙÔÓ ÙÚfiÔ ·˘Ùfi ÌÔÚ› Ó· Â¿ÁÂÈ
ÙËÓ ·ÚÔ˘Û›·ÛË citrullinated ÂÈÙfiˆÓ ÛÙÔ ·ÓÔ-
ÛÈ·Îfi Û‡ÛÙËÌ·11.
™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ·ÓÙÈ-CCP ·ÓÙÈÛÒÌ·Ù· ›-
Ó·È ‰È·ÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ Ù˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·Ú-
27
K C
K
∏ π·ÙÚÈ΋ ™‹ÌÂÚ·
ıÚ›Ùȉ·˜. ∏ ¢·ÈÛıËÛ›· ÛÙË ‰È¿ÁÓˆÛË Ù˘ Ú¢-
Ì·ÙÔÂȉԇ˜ ·ÚıÚ›Ùȉ·˜ ÔÈΛÏÏÂÈ ·Ó¿ÏÔÁ· Ì ÙËÓ
ÔÌ¿‰· ·ÛıÂÓÒÓ. ŸÛÔÓ ·ÊÔÚ¿ ÙË ‰È¿ÁÓˆÛË Ù˘
ÚÒÈÌ˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·ÚıÚ›Ùȉ·˜ Ë Â˘·ÈÛıË-
Û›· ÙÔ˘˜ Â›Ó·È ÌÈÎÚfiÙÂÚË12. ™ÙËÓ ÔÌ¿‰· ·˘Ù‹ Ô
Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ ·ÓÙÈ-CCP Ì ÙÔÓ ÚÂ˘Ì·ÙÔÂȉ‹
·Ú¿ÁÔÓÙ· ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË Â˘·ÈÛıËÛ›·. ∏ ÛË-
Ì·Û›· Ù˘ ·Ó›¯Ó¢Û˘ ÙˆÓ ·ÓÙÈ-CCP ·ÓÙÈۈ̿-
ÙˆÓ Â›Ó·È ÌÂÁ¿ÏË Î·ıÒ˜ Ë ·Ó·ÁÓÒÚÈÛË ‰ÂÈÎÙÒÓ
η΋˜ ÚfiÁÓˆÛ˘ ÓˆÚ›˜ ÛÙËÓ ÔÚ›· Ù˘ ÚÂ˘Ì·-
ÙÔÂȉԇ˜ ‰È¢ÎÔχÓÂÈ ÙȘ ıÂÚ·¢ÙÈΤ˜ ·ÔÊ¿-
ÛÂȘ.
3.4. ÕÏÏ· ·˘ÙÔ·ÓÙÈÛÒÌ·Ù·
À¿Ú¯Ô˘Ó Î·È ¿ÏÏ· ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· Ô˘ ›-
Ó·È ÂȉÈο ÁÈ· ÙË ÚÂ˘Ì·ÙÔÂȉ‹ ·ÚıÚ›Ùȉ· fiˆ˜ Ô
ÂÚÈ˘ÚËÓÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Î·È Ù· ·ÓÙÈÎÂÚ·ÙÈÓÈο
·ÓÙÈÛÒÌ·Ù·. ¢ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â˘Ú¤ˆ˜ ÏfiÁˆ
Ù¯ÓÈÎÒÓ ‰˘ÛÎÔÏÈÒÓ ÛÙËÓ ·Ó›¯Ó¢ÛË.
4. ∏ ™ÀªμO§H Δ∏™ ∂ƒ°∞™Δ∏ƒπ∞∫∏™
¢π∂ƒ∂À¡∏™∏™ ™Δ∏¡ ∂¶π§O°H
£∂ƒ∞¶∂ÀΔπ∫ø¡ Ã∂πƒπ™ªø¡
™ÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÚÂ˘Ì·ÙÔ-
Âȉԇ˜ ·ÚıÚ›Ùȉ·˜ ¤¯Ô˘Ó ÂÈÛ¤ÏıÂÈ ÔÈ ‚ÈÔÏÔÁÈÎÔ›
·Ú¿ÁÔÓÙ˜. ∏ Ó¤· ¤ÌÊ·ÛË ÛÙË ¯ÔÚ‹ÁËÛË ÂÈıÂ-
ÙÈÎÒÓ ÌÔÚÊÒÓ ıÂÚ·›·˜ ÓˆÚ›˜ ÛÙËÓ ÔÚ›· Ù˘
ÓfiÛÔ˘ ÂÏ·ÙÙÒÓÂÈ ÙË ÓÔÛËÚfiÙËÙ· Î·È Èı·ÓÒ˜
ÚÔÏ·Ì‚¿ÓÂÈ ÙËÓ ·Ó·ËÚ›·. OÈ ‚ÈÔÏÔÁÈÎÔ› ·Ú¿-
ÁÔÓÙ˜ ÛÙÔ¯Â‡Ô˘Ó ‰È¿ÊÔÚÔ˘˜ Û˘ÓÙÂÏÂÛÙ¤˜ Ù˘
¿ÓÔÛ˘ ·fiÎÚÈÛ˘, fiˆ˜ Â›Ó·È Ô ·Ú¿ÁÔÓÙ·˜ Ó¤-
ÎÚˆÛ˘ ÙˆÓ fiÁΈÓ-· (TNF-·) Î·È Ù· μ ÏÂÌÊÔ·Ù-
Ù·Ú·. ∏ ·Ó›¯Ó¢ÛË ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ‰ÂÈÎÙÒÓ ‚·-
Ú‡ÙËÙ·˜ Ù˘ ÓfiÛÔ˘, fiˆ˜ Â›Ó·È Ô ÚÂ˘Ì·ÙÔÂȉ‹˜
·Ú¿ÁÔÓÙ·˜ Î·È Ù· ·ÓÙÈ-CCP ·ÓÙÈÛÒÌ·Ù· ÌÔÚ›
Ó· ηıÔ‰ËÁ‹ÛÂÈ ÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË
Ù˘ ÓfiÛÔ˘. ∂ȉÈÎfiÙÂÚ·, ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ
¤ÁηÈÚË ÂÊ·ÚÌÔÁ‹ ‚ÈÔÏÔÁÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘
ı· ·Ó·ÛÙ›ÏÔ˘Ó ÙËÓ ÂͤÏÈÍ‹ Ù˘. O ÚÂ˘Ì·ÙÔÂȉ‹˜
·Ú¿ÁÔÓÙ·˜ Î·È Ù· ·ÓÙÈ-CCP ·ÓÙÈÛÒÌ·Ù· ·Ú¿-
ÁÔÓÙ·È ·fi Ù· μ ÏÂÌÊÔ·ÙÙ·Ú·13. ∏ ·Ó›¯Ó¢ÛË
ÙÔ˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·Ú¿ÁÔÓÙ·14,15, fiˆ˜ Î·È Ë
·Ó›¯Ó¢ÛË ÙˆÓ ·ÓÙÈ-CCP ·ÓÙÈۈ̿وÓ, ÌÔÚ› Ó·
Û˘Ì‚¿ÏÂÈ ÛÙËÓ ·fiÊ·ÛË ÁÈ· ÂÈÏÔÁ‹ ‚ÈÔÏÔÁÈÎÔ‡
·Ú¿ÁÔÓÙ·, ηıÒ˜ ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ Û ·˘Ù‹
ÙËÓ ÂÚ›ÙˆÛË Ë ÓfiÛÔ˜ ·ÓÙ·ÔÎÚ›ÓÂÙ·È Î·Ï‡ÙÂ-
Ú· ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ‚ÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ· Ô˘
ÛÙԯ‡ÂÈ Ù· μ ÏÂÌÊÔ·ÙÙ·Ú·, fiˆ˜ Â›Ó·È Ë ÚÈ-
ÙÔ˘ÍÈÌ¿ÌË.
K
K C
∏ π·ÙÚÈ΋ ™‹ÌÂÚ·
5. ™Àª¶∂ƒ∞™ª∞
∏ ÚÂ˘Ì·ÙÔÂȉ‹˜ ·ÚıÚ›Ùȉ· Â›Ó·È ÓfiÛÔ˜ ÛÙËÓ
·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ÔÔ›·˜ Û˘ÌÌÂÙ¤¯ÂÈ Ë ·˘ÙÔ-
·ÓÔÛ›·. ∏ ÂÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË Û˘Ì‚¿ÏÏÂÈ
ÙfiÛÔ ÛÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ fiÛÔ Î·È ÛÙÔÓ Î·-
ıÔÚÈÛÌfi Ù˘ ÔÚ›·˜ Î·È ÚfiÁÓˆÛ‹˜ Ù˘. Δ· ·-
ÓÙÈ-CCP ·ÓÙÈÛÒÌ·Ù· Â›Ó·È ‰È·ÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘
Ù˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·ÚıÚ›Ùȉ·˜ Î·È ÚÔÁÓˆÛÙÈ-
Îfi˜ ‰Â›ÎÙ˘ ‚·Ú‡ÙËÙ·˜ Ù˘ ÓfiÛÔ˘. ∏ ·Ó›¯Ó¢ÛË
ÙÔ˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·Ú¿ÁÔÓÙ· Î·È ÙˆÓ ·ÓÙÈ-CCP
·ÓÙÈÛˆÌ¿ÙˆÓ ÌÔÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ¤ÁηÈÚË
Î·È Î·Ï‡ÙÂÚË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ófi-
ÛÔ˘ ηıÔ‰ËÁÒÓÙ·˜ ÙȘ ıÂÚ·¢ÙÈΤ˜ ÂÈÏÔÁ¤˜
Î·È ‰È¢ÎÔχÓÔÓÙ·˜ ÙȘ ıÂÚ·¢ÙÈΤ˜ ·ÔÊ¿ÛÂȘ.
μÈ‚ÏÈÔÁÚ·Ê›·
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The American Rheumatism Association 1987 revised criteria
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cent C, Girbal-Neuhauser E, Durroux R, Cantagrel A, Serre G.
In the rheumatoid pannus, anti-filaggrin autoantibodies are
\EÏ¢ı¤ÚÔ˘ àÓ‰Úe˜ Ù’ àÏËıÉ Ï¤ÁÂÈÓ
ÿ‰ÈÔÓ ÙÔ˘ ÂÏ¢ı¤ÚÔ˘ ·ÓıÚÒÔ˘ Â›Ó·È Ó· ϤÂÈ ÙËÓ ·Ï‹ıÂÈ·
™ÔÊÔÎÏ‹˜
28
K C
K
produced by local plasma cells and constitute a higher propor-
tion of IgG than in synovial fluid and serum. Clin Exp Immunol
2000;119:544-52.
7. Schellekens GA, Visser H, de Jong BA, van den Hoogen FH,
Hazes JM, Breedveld FC, van Venrooij WJ. The diagnostic
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Nogueira L, Vincent C, Senshu T, Serre G. The major synovial
targets of the rheumatoid arthritis-specific antifilaggrin autoanti-
bodies are deiminated forms of the alpha- and beta-chains of
fibrin. J Immunol 2001;166:4177-84.
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