Rheumatoid arthritis is a chronic multifactorial inflammatory disease. Proinflammatory cytokines, such as TNF-alpha and IL-6, secreted by macrophages and monocytes have an important pathogenic role in the phases of inflammation, synovial proliferation and cartilage damage [10]. Rheumatoid factor (RF) has been the most widely used antibody to diagnose RA [11]; anti-citrullinated protein antibodies (ACPA) have also been included in the diagnostic criteria of ACR/EULAR in 2010 [12] and they are highly associated with the development of erosive RA [13].