Uromodulin in Rheumatoid Arthritis

Study Overview
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Brief Summary
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The aim of the present study was to evaluate the levels of uromodulin in rheumatoid arthritis (RA) and to investigate whether it was correlated with baseline clinical characteristics. In addition CKD epi,MDRD,urine microalbuminuria,pH,serum urea, creatinine,CRP (C-Reactive protein) were measured.The participants consist of ; %68 patients,% 32 control group.

Detailed Description
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Uromodulin, also known as Tamm-Horsfall protein, is a protein abundantly excreted in the urine in healthy individuals. It is synthesized in the thick ascending limb of Henle (TALH) and the early distal convoluted tubule. Its biologic function is still obscure; however, some experimental studies indicated that it might serve as an important urinary defense factor against bacterial colonization and stone formation. There are controversial publications on the frequencies of urinary tract infections and nephrolithiasis in patients with mutations of uromodulin gene. Deposition of mutated uromodulin in the urinary system may lead to tubular cell dysfunction and apoptosis. These alterations may subsequently cause tubular atrophy and interstitial fibrosis . Moreover, the release of abnormal uromodulin after apoptosis through basolateral secretion may elicit an immune response which may give rise to an immune-mediated tubulointerstitial nephritis . Uromodulin can activate the other components of the immune system and may modulate the inflammatory and immune responses through different mechanisms . Experimental studies yielded that uromodulin negative mice displayed splenomegaly with infiltration of white pulp by macrophages and increased levels of TNF-α and interleukin-1 . Rheumatoid arthritis is a systemic autoimmune condition that may eventually result in the joint damage, disability and premature mortality.

Official Title
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Uromodulin Levels in Rheumatoid Arthritis

Conditions
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Rheumatoid Arthritis

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who diagnosed of rheumatoid arthritis as criteria of ACR/EULAR 2010. All patients age range is 18-80 years. Exclusion Criteria : Renal failure Hepatic insufficiency Diabetes mellitus Other collagen vascular diseases, History of smoking and consumption of alcohol

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| ra patients<br>The diagnosis of RA was based on the criteria developed by the American College of Rheumatology and European League Against Rheumatism (ACR/EULAR) in 2010 [8]. A drug history was obtained from every patient. All non-steroidal anti-inflammatory medications and disease-modifying antirheumatic drugs prescribed during the year before enrollment in the study were recorded. criteria included systemic diseases (renal failure, hepatic insufficiency, diabetes mellitus, other collagen vascular diseases, history of smoking and consumption of alcohol.In order to eliminate the possibility of any systemic disease therefore we choose that our control group as young. | |
| healthy control<br>healthy person, similar population | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patients with rheumatoid arthritis | The diagnosis of RA was based on the criteria the American College of Rheumatology and European League Against Rheumatism (ACR/EULAR) in 2010. Patients selected have at least 1 joint with definite clinical synovitis (swelling) with the synovitis not better explained by another disease Classification criteria for RA (score-based algorithm: add score of categories A-D; a score of >6/10 is needed for classification of a patient as having definite RA) | 1 day | 
| A.joint involvement | 1 large joint (score 0) 2-10 large joints (score 1) 1-3 small joints (with or without involvement of large joints)#(score2) 4-10 small joints (with or without involvement of large joints)(score 3) 10 joints (at least 1 small joint) (score 5) | 1 day | 
| B.Serology (at least 1 test result is needed for classification) | Negative RF and negative ACPA (Score 0) Low-positive RF or low-positive ACPA( anticitrullinated protein antibody) (score 2) High-positive RF(rheumatoid factor) or high-positive ACPA (score 3) | 1 day | 
| C.Acute-phase reactants (at least 1 test result is needed for classification) | Normal CRP (C-reactive protein and normal) and normal ESR (erythrocyte sedimentation rate) (score 0) Abnormal CRP or abnormal ESR (score1) | 1 day | 
| D.Duration of symptoms | <6 weeks (score 0) >6 weeks (score 1) | 1 day | 
| Uromodulin measure | First urine sample taken in the morning | 1 day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| CKD-EPI (Chronic Kidney Disease Epidemiology Colloboration) | For estimating the glomerular filtration rate | 1 day | 
| MDRD (Modification of Diet in Renal Disease) | For estimating the glomerular filtration rate | 1 day | 
| Urea measure | Fasting blood samples taken in the morning | 1 day | 
| Creatinine measure | Fasting blood samples taken in the morning | 1 day | 
| Sedimantation measure | Fasting blood samples taken in the morning | 1 day | 
| pH measure | First urine sample taken in the morning | 1 day | 
| Microalbuminuria measure | First urine sample taken in the morning | 1 day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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uromodulin