Marti C, Neidhart M, Gerber T, Hauser N, Michel B A, Häuselmann H J
Rheumaklinik und Institut für Physikalische Medizin Universitätsspital Zürich.
Z Rheumatol. 1999 Apr;58(2):79-87. doi: 10.1007/s003930050156.
Today, we can assess criteria to predict the tissue destruction and progression of Rheumatoid Arthritis (RA) and Osteoarthritis (OA) only in a late stage of the disease. It would be an advantage to have biochemical markers of disease activity and joint destruction to optimize therapy.
In this cross-sectional study with 37 RA and 20 OA patients (disease duration 119 +/- 130 months for RA and 41 +/- 73 months for OA), ESR, CRP, disease activity score (DAS), the functional status of RA (American College of Rheumatology), and the radiological scoring systems of Larsen and Kellgren/Lawrence, respectively, were used as parameters for disease activity and joint destruction. Cartilage oligomeric matrix protein (COMP) was measured with an enzyme-linked immunosorbent assay (ELISA) in serum and synovial fluid, COMP fragments with immunoblot in the synovial fluid.
The mean COMP value in synovial fluid was 38 ug/ml (RA) and 46 ug/ml (OA); 6.5 ug/ml (RA) and 3.4 ug/ml (OA) in serum. RA patients had a higher amount of small COMP fragments in synovial fluid than OA patients. In RA patients, there was a significant positive correlation between disease activity (DAS) and COMP in synovial fluid and serum, a negative correlation between functional status of RA and serum COMP and between radiologic joint destruction of the knee and serum COMP. In OA patients, there was a significant correlation of joint space width and synovial fluid COMP.
A high clinical disease activity (DAS) correlated with high COMP values in serum and synovial fluid and with increasing proteolytic activity (higher amount of small COMP fragments especially in RA). An increased turnover of cartilage matrix in joint inflammation might explain this correlation. The correlation of decreased COMP with decreased functional status in RA and increased joint destruction is compatible with a loss of cartilage and less turnover. The correlation between joint space width and increased COMP in OA patients with short disease duration might be explained with a higher turnover of the cartilage matrix in the early stage of the disease.
如今，我们仅能在类风湿关节炎（RA）和骨关节炎（OA）疾病的晚期评估预测组织破坏和疾病进展的标准。拥有疾病活动和关节破坏的生化标志物以优化治疗将是一大优势。
在这项横断面研究中，纳入了37例RA患者和20例OA患者（RA的病程为119±130个月，OA的病程为41±73个月），分别将红细胞沉降率（ESR）、C反应蛋白（CRP）、疾病活动评分（DAS）、RA的功能状态（美国风湿病学会标准）以及Larsen和Kellgren/Lawrence放射学评分系统用作疾病活动和关节破坏的参数。采用酶联免疫吸附测定（ELISA）法检测血清和滑液中的软骨寡聚基质蛋白（COMP），通过免疫印迹法检测滑液中的COMP片段。
滑液中COMP的平均浓度在RA患者中为38μg/ml，在OA患者中为46μg/ml；血清中分别为6.5μg/ml（RA）和3.4μg/ml（OA）。RA患者滑液中COMP小片段的含量高于OA患者。在RA患者中，疾病活动度（DAS）与滑液及血清中的COMP呈显著正相关，RA的功能状态与血清COMP以及膝关节放射学关节破坏与血清COMP呈负相关。在OA患者中，关节间隙宽度与滑液COMP显著相关。
高临床疾病活动度（DAS）与血清和滑液中高COMP值以及蛋白水解活性增加（尤其是RA中COMP小片段含量更高）相关。关节炎症中软骨基质周转率增加可能解释了这种相关性。RA中COMP降低与功能状态下降及关节破坏增加之间的相关性与软骨丢失和周转率降低相符。疾病病程较短的OA患者中关节间隙宽度与COMP增加之间的相关性可能可以用疾病早期软骨基质周转率较高来解释。
