Division of Rheumatology, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
Ann Rheum Dis. 2011 Sep;70(9):1562-8. doi: 10.1136/ard.2011.150813. Epub 2011 May 13.
Adipokines have inflammatory and immunomodulatory properties that may contribute to erosive joint damage. The association of serum adipokine levels with progression of radiographic joint damage in patients with rheumatoid arthritis (RA) was prospectively explored.
Patients with RA underwent serum adipokine assessment (adiponectin, resistin, leptin) at three timepoints and hand/feet x-rays, scored using the Sharp-van der Heijde Score (SHS), at baseline and the third study visit, separated by an average of 39±4 months. The associations of baseline and average adipokine levels with change in SHS were explored, adjusting for pertinent confounders.
Of the 152 patients studied, 85 (56%) showed an increase in SHS (defined as >0 SHS units). Among the adipokines studied, only adiponectin was significantly associated with radiographic progression, with average adiponectin levels more strongly associated than baseline levels. After adjusting for average C reactive protein and baseline SHS, patients in the highest quartile of average adiponectin had a SHS progression rate more than double the lowest quartile (1.00 vs 0.48 units/year; p=0.008). Similarly, those in the highest quartile of adiponectin had a more than fivefold greater odds of any radiographic progression compared with the lowest quartile (OR 5.75; p=0.002). The magnitude of the association of average adiponectin levels with radiographic progression was greater in women, those with body mass index <30 kg/m(2) and those receiving baseline biological disease-modifying antirheumatic drugs.
These prospective data provide evidence of temporality and dose-response in the relationship between circulating adiponectin and erosive joint destruction in RA, and highlight subgroups of patients at highest risk for adiponectin-associated radiographic progression.
脂肪细胞因子具有炎症和免疫调节特性，可能导致侵蚀性关节损伤。本研究前瞻性探讨了血清脂肪细胞因子水平与类风湿关节炎（RA）患者放射学关节损伤进展的关系。
RA 患者在三个时间点进行血清脂肪细胞因子评估（脂联素、抵抗素、瘦素），并在基线和第三次研究访问时进行手部/足部 X 射线检查，使用 Sharp-van der Heijde 评分（SHS）进行评分，平均间隔 39±4 个月。在调整相关混杂因素后，探讨基线和平均脂肪细胞因子水平与 SHS 变化的关系。
在研究的 152 名患者中，85 名（56%）SHS 增加（定义为>0 SHS 单位）。在所研究的脂肪细胞因子中，只有脂联素与放射学进展显著相关，平均脂联素水平与基线水平相比相关性更强。在校正平均 C 反应蛋白和基线 SHS 后，平均脂联素最高四分位的患者 SHS 进展率是最低四分位的两倍多（1.00 比 0.48 单位/年；p=0.008）。同样，与最低四分位相比，脂联素最高四分位的患者任何放射学进展的可能性高出五倍以上（OR 5.75；p=0.002）。在女性、BMI<30 kg/m(2)和基线接受生物疾病修饰抗风湿药物的患者中，平均脂联素水平与放射学进展之间的关联程度更大。
这些前瞻性数据为 RA 患者循环脂联素与侵蚀性关节破坏之间的时间和剂量-反应关系提供了证据，并突出了脂联素相关放射学进展风险最高的患者亚组。
