Article Text

Download PDFPDF
Diagnostic value of the serum Midkine in patients with rheumatoid arthritis
  1. Muhammad Tarek Abdel Ghafar1,
  2. Soheir Abdel Haleem1,
  3. Abeer Shahba2,
  4. Aalaa M Sweilam1
  1. 1 Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
  2. 2 Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
  1. Correspondence to Dr Muhammad Tarek Abdel Ghafar, Clinical Pathology, Tanta University Faculty of Medicine, Tanta 31511, Egypt; mohammedtarek5514{at}


Early diagnosis and detection of rheumatoid arthritis (RA) activity which is a potential therapeutic target, depends mainly on clinical presentation. However, laboratory tests may contribute to diagnosis and disease activity assessment of RA. This study aims to evaluate the accuracy of serum Midkine as serological marker for RA diagnosis and its activity detection. All patients with RA were recruited during the period from January 2016 to August 2018 in addition to healthy subjects as control. Serum Midkine level was estimated using enzyme immunoassay. The accuracy was determined for serum Midkine against the used American College of Rheumatology/European League Against Rheumatism 2010 classification criteria for RA diagnosis and disease activity score derivative for 28 joints-erythrocyte sedimentation rate (ESR) score for assessment of RA disease activity. A total of 211 of patients with RA (group I) were enrolled in this study with 112 healthy subjects (group II). Patients with RA were divided into two subgroups according to the disease activity; patients with active RA (group IA) and RA in remission (group IB). We detected that the area under curve (AUC) of serum Midkine level (AUC=0.851) was significantly lower than that of rheumatoid factor IgM and anti-cyclic citrullinated peptide IgG for RA diagnosis. However, Midkine presents a significantly higher diagnostic accuracy (AUC=0.939) in detecting RA activity than that offered by C reactive protein (CRP) or ESR. Our study suggested that serum Midkine is a potential serological marker for detection of active inflammatory state with higher diagnostic accuracy than other inflammatory markers as CRP or ESR. Therefore, it can be used as an inflammatory marker for detection of disease activity rather than diagnosis of RA.

  • rheumatoid arthritis
  • Midkine
  • DAS score
  • accuracy
  • activity

Statistics from


  • Contributors All authors contributed equally in the writing of this manuscript. MTAG, SAH and AMS participated mainly in the study designing, and the biochemical analysis. AS contributed specifically in patients’ selection and partitioning. MTAG shared in the analysis of data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval All procedures and protocols were designed in accordance with the Helsinki declaration and approved by our national ethics committee (ethics committee, Faculty of Medicine, Tanta University).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.