Pulsatelli Lia, Boiardi Luigi, Pignotti Elettra, Dolzani Paolo, Silvestri Tania, Macchioni Pierluigi, Cantini Fabrizio, Salvarani Carlo, Facchini Andrea, Meliconi Riccardo
Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, Italy.
Arthritis Rheum. 2008 Aug 15;59(8):1147-54. doi: 10.1002/art.23924.
To investigate the modulation of systemic levels of soluble interleukin-6 receptor (sIL-6R) and soluble gp130 (sgp130) in untreated and treated polymyalgia rheumatica (PMR) patients during a followup period of at least 24 months in order to evaluate the relationship of these molecules with clinical outcome and their feasibility to provide a prognostic tool in clinical practice.
We analyzed sIL-6R and sgp130 serum levels in 93 PMR patients, and 46 age-matched normal controls, at disease onset and at 1, 3, 6, 12, and 24 months of followup during corticosteroid therapy by enzyme-linked immunosorbent assay.
No difference in sIL-6R and sgp130 levels was observed between PMR patients and normal controls at disease onset or during followup. A significant correlation was found between the number of relapses and sIL-6R concentrations at baseline and after 1, 3, and 12 months of therapy. No correlation was found between sgp130 levels and the number of relapses. Cox multivariate analysis indicated that the best model for predicting relapses was identified by sIL-6R levels and the hemoglobin value at baseline. We found that high sIL-6R levels combined with low hemoglobin values resulted in a 10.1-fold increased risk of relapse.
Our data support the identification of a potential prognostic marker of PMR outcome that might have important implications in clinical practice. Because targeting sIL-6R with blocking antibodies has proven useful in other rheumatic disorders, our results could suggest the opportunity to evaluate sIL-6R-blocking treatment in patients with PMR and elevated levels of sIL-6R at disease onset.
在至少24个月的随访期内，研究未经治疗和接受治疗的风湿性多肌痛（PMR）患者体内可溶性白细胞介素-6受体（sIL-6R）和可溶性gp130（sgp130）的全身水平调节情况，以评估这些分子与临床结局的关系，及其在临床实践中作为预后工具的可行性。
我们采用酶联免疫吸附测定法，分析了93例PMR患者和46例年龄匹配的正常对照在疾病发作时以及糖皮质激素治疗期间随访1、3、6、12和24个月时的sIL-6R和sgp130血清水平。
在疾病发作时或随访期间，PMR患者与正常对照之间的sIL-6R和sgp130水平无差异。在基线以及治疗1、3和12个月后，复发次数与sIL-6R浓度之间存在显著相关性。sgp130水平与复发次数之间未发现相关性。Cox多变量分析表明，预测复发的最佳模型由基线时的sIL-6R水平和血红蛋白值确定。我们发现，高sIL-6R水平与低血红蛋白值相结合会使复发风险增加10.1倍。
我们的数据支持确定一种可能对临床实践具有重要意义的PMR结局潜在预后标志物。由于用阻断抗体靶向sIL-6R已在其他风湿性疾病中证明有效，我们的结果可能提示有机会评估在疾病发作时sIL-6R水平升高的PMR患者进行sIL-6R阻断治疗的可能性。
