Evaluation of adrenomedullin, growth differentiation factor-15, and atrial natriuretic peptide in patients with rheumatoid arthritis

Abstract

Introduction and aim. Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by joint inflammation and systemic complications, including cardiovascular involvement. This study evaluated the diagnostic utility of angiotensinogen (AGT), serum amyloid A-4 protein (SAA4) and C-reactive protein (CRP) in RA, along with new cardiac biomarkers adrenomedullin (ADM), growth differentiation factor-15 (GDF-15), and atrial natriuretic peptide (ANP), to assess cardiac complications. Material and methods. This case-control study included 61 RA patients (divided into newly diagnosed, sDMARD-treated, and sDMARD/bDMARD-treated groups) and 27 healthy controls. Serum levels of AGT, SAA4, CRP, ADM, GDF-15, and ANP were measured using ELISA. Statistical analyses were performed using SPSS software. Results. RA patients exhibited significantly elevated levels of AGT (40.841±17.285 µg/mL), SAA4 (48.128±17.065 ng/mL), CRP (13.097±18.702 mg/L), ADM (96.295±19.424 pg/mL), GDF-15 (1247.049±854.335 pg/mL), and ANP (334.016±40.874 pg/mL) levels compared to controls (p≤0.001). No significant differences were observed between the treatment groups for AGT, SAA4, or CRP levels. Cardiac biomarkers (ADM, GDF-15, and ANP) remained elevated in all RA groups, with strong inter-parameter correlations (Spearman r>0.6). Conclusion. AGT, SAA4, and CRP demonstrate robust diagnostic value for RA. Persistent elevation of ADM, GDF-15, and ANP in all patient groups confirms significant cardiac involvement in RA.