Predicting Thrombosis Risk in Rheumatoid Arthritis: The Combined Effects of Anti-MCV Antibodies, D-dimer and Disease Activity

Rheumatoid arthritis (RA) carries an elevated risk of thrombotic complications, a major contributor to cardiovascular morbidity in this population. This case-control study aimed to identify predictive factors for thrombosis risk in RA and D-dimer roles, focusing on anti-mutated citrullinated vimentin (anti-MCV) antibodies and disease activity. Sixty-five RA patients and 25 age-matched female controls were recruited from Al-Sadder Teaching Hospital, Iraq (September–November 2024). Disease activity was assessed via DAS28-CRP, alongside biomarkers (CRP, ESR, D-dimer, anti-MCV), lipid profiles, and platelet counts. RA patients exhibited significantly elevated CRP (9.19 vs. 2.45 mg/L, p<0.0001), D-dimer (0.66 vs. 0.29 μg/mL, p<0.001), anti-MCV (7.96 vs. 2.63 U/mL, p<0.001), and ESR (38.34 vs. 18.99 mm/hr, p<0.001) compared to controls. Higher disease activity (DAS28-CRP ≥3.25) correlated with older age (OR:7.600; 95%CI:2.173–26.583), elevated CRP (OR:7.000; 95%CI:3.171–15.454), and D-dimer (OR:13.176; 95%CI:2.676–64.879). Anti-MCV levels showed a weaker association (OR:3.846; 95%CI:0.452–32.695, p=0.036). ROC analysis identified CRP (AUC:0.99, sensitivity:100%, specificity:94%) and D-dimer (AUC:0.87) as robust discriminators of moderate-to-high disease activity, while anti-MCV demonstrated poor discriminatory capacity (AUC:0.60, p=0.334). Correlation analyses revealed strong associations between DAS28-CRP and CRP (r=0.871), D-dimer (r=0.792), and ESR (r=0.541), but only a modest link with anti-MCV (r=0.313). In conclusion, systemic inflammation (CRP, D-dimer) and age, rather than anti-MCV, are critical predictors of thrombosis risk in RA. Anti-MCV’s limited discriminatory utility suggests its role in RA pathophysiology may not directly translate to thrombosis risk stratification. These findings underscore the importance of integrating inflammatory biomarkers into RA management protocols to address cardiovascular morbidity.