Department of Rheumatology, Diakonhjemmet Hospital, PB 23 Vindern, N-0319 Oslo, Norway.
Ann Rheum Dis. 2010 May;69(5):845-50. doi: 10.1136/ard.2009.122325. Epub 2010 Mar 16.
To examine associations between a panel of soluble biomarkers and progressive joint destruction assessed by magnetic resonance imaging (MRI) and conventional radiographs as well as longitudinal associations with disease activity assessed clinically and by MRI in early rheumatoid arthritis (RA) patients.
84 early RA patients were evaluated at baseline, 3, 6 and 12 months with clinical examination, serum and urine sampling, MRI scans of the dominant wrist and conventional radiographs of the hands. A panel of biomarkers (sCTX-I, uCTX-II, sOPG, sYKL-40, sCOMP and sMMP-3) was assessed by ELISA. MRI images and conventional radiographs were scored according to the RA MRI score (RAMRIS) and the van der Heijde modified Sharp score (SHS), respectively. Longitudinal associations between biomarkers and MRI inflammation and disease activity score (DAS28) and association with the progression of damage were examined with adjustments for known predictors.
The baseline sCTX-I level predicted progression in joint destruction assessed by MRI and conventional radiographs, whereas the uCTX-II level was a predictor of progression in SHS but not RAMRIS. Consistent associations, both with MRI inflammation (synovitis and bone marrow oedema) and DAS28 were found for sYKL-40 and sMMP-3 in addition to C-reactive protein at baseline and in longitudinal analyses. Associations remained significant in multivariate analyses.
Levels of sCTX-I and uCTX-II were significant predictors of progressive joint destruction, whereas sMMP-3 and sYKL-40 were merely markers of joint inflammation. The clinical value of these markers for use in individual patients is limited due to a considerable overlap in levels of patients with progression and no progression.
探讨一组可溶性生物标志物与磁共振成像（MRI）和常规 X 线评估的进行性关节破坏之间的相关性，以及与早期类风湿关节炎（RA）患者临床和 MRI 评估的疾病活动的纵向相关性。
84 例早期 RA 患者在基线时、3、6 和 12 个月时进行临床检查、血清和尿液采样、优势腕关节 MRI 扫描和手部常规 X 线摄影。通过 ELISA 评估一组生物标志物（sCTX-I、uCTX-II、sOPG、sYKL-40、sCOMP 和 sMMP-3）。MRI 图像和常规 X 线片分别根据 RA MRI 评分（RAMRIS）和 van der Heijde 改良 Sharp 评分（SHS）进行评分。通过调整已知预测因子，检查生物标志物与 MRI 炎症和疾病活动评分（DAS28）之间的纵向相关性以及与损伤进展的相关性。
基线 sCTX-I 水平预测 MRI 和常规 X 线评估的关节破坏进展，而 uCTX-II 水平是 SHS 但不是 RAMRIS 进展的预测因子。除基线时的 C 反应蛋白外，sYKL-40 和 sMMP-3 还与 MRI 炎症（滑膜炎和骨髓水肿）和 DAS28 存在一致的相关性，并且在纵向分析中也是如此。多元分析结果仍具有统计学意义。
sCTX-I 和 uCTX-II 水平是进行性关节破坏的重要预测因子，而 sMMP-3 和 sYKL-40 只是关节炎症的标志物。由于进展和无进展患者的水平存在很大重叠，这些标志物在个体患者中的临床应用价值有限。
