Meyer Magali, Sellam Jérémie, Fellahi Soraya, Kotti Salma, Bastard Jean-Philippe, Meyer Olivier, Lioté Frédéric, Simon Tabassome, Capeau Jacqueline, Berenbaum Francis
Arthritis Res Ther. 2013;15(6):R210. doi: 10.1186/ar4404.
Adipokines such as adiponectin, leptin, and visfatin/nicotinamide phosphoribosyltransferase (NAMPT) have recently emerged as pro-inflammatory mediators involved in the pathophysiology of rheumatoid arthritis (RA). We aimed to determine whether serum adipokine levels independently predicted early radiographic disease progression in early RA.
In total, 791 patients were included from the prospective Etude et Suivi des POlyarthrites Indifférenciées Récentes (ESPOIR) cohort who met the American College of Rheumatology-European League Against Rheumatism criteria for RA (n = 632) or had undifferentiated arthritis (UA) (n = 159). Enzyme-linked immunosorbent assay (ELISA) was used to assess baseline serum levels of adiponectin, leptin, and visfatin/NAMPT. In the RA group, we tested the association of serum adipokine levels and (a) baseline radiographic damage and (b) radiographic disease progression, defined as a change >0 or ≥ 5 in total Sharp-van der Heijde Score (∆SHS) between inclusion and 1 year (∆SHS ≥1 or rapid radiographic progression: ∆SHS ≥5), adjusting for confounders (age, sex, body-mass index, insulin resistance, C-reactive protein level, Disease Activity Score in 28 joints, Health Assessment Questionnaire score, autoantibody status, steroid use, and radiographic evidence of RA damage at inclusion).
Adiponectin level was independently associated with baseline total SHS (adjusted β = 0.12; P = 0.006). It was also associated with ∆SHS ≥1 (adjusted odds ratio (aOR) = 1.84 (1.25 to 2.72)) involving erosive as well as narrowing disease progression (aOR = 1.73 (1.17 to 2.55) and 1.93 (1.04 to 3.57), respectively). Serum adiponectin level predicted ∆SHS ≥5 (aOR = 2.0 (1.14 to 3.52)). Serum leptin level was independently associated only with ∆SHS >0 (aOR = 1.59 (1.05 to 2.42)). Conversely, serum visfatin/NAMPT level and radiographic disease progression were unrelated. Considering the receiver-operated characteristic curves, the best adiponectin cut-offs were 4.14 μg/ml for ∆SHS ≥1 and 6.04 μg/ml for ∆SHS ≥5, with a good specificity (58% and 75% for ∆SHS ≥1 and ∆SHS ≥5, respectively) and high negative predictive values (75% and 92% for ∆SHS ≥1 or ∆SHS ≥5, respectively).
Serum adiponectin level is a simple useful biomarker associated with early radiographic disease progression in early RA, independent of RA-confounding factors and metabolic status.
脂联素、瘦素和内脂素/烟酰胺磷酸核糖转移酶（NAMPT）等脂肪因子最近已成为参与类风湿关节炎（RA）病理生理学的促炎介质。我们旨在确定血清脂肪因子水平是否能独立预测早期RA的早期影像学疾病进展。
前瞻性的近期未分化多关节炎研究（ESPOIR）队列共纳入791例患者，这些患者符合美国风湿病学会-欧洲抗风湿病联盟的RA标准（n = 632）或患有未分化关节炎（UA）（n = 159）。采用酶联免疫吸附测定（ELISA）评估脂联素、瘦素和内脂素/NAMPT的基线血清水平。在RA组中，我们测试了血清脂肪因子水平与（a）基线影像学损伤和（b）影像学疾病进展之间的关联，影像学疾病进展定义为入组时和1年之间总Sharp-van der Heijde评分（∆SHS）变化>0或≥5（∆SHS≥1或快速影像学进展：∆SHS≥5），并对混杂因素（年龄、性别、体重指数、胰岛素抵抗、C反应蛋白水平、28个关节疾病活动评分、健康评估问卷评分、自身抗体状态、类固醇使用以及入组时RA损伤的影像学证据）进行了校正。
脂联素水平与基线总SHS独立相关（校正β = 0.12；P = 0.）。它也与∆SHS≥1相关（校正比值比（aOR）= 1.84（1.25至2.72）），涉及侵蚀性和狭窄性疾病进展（分别为aOR = 1.73（1.17至2.55）和1.93（1.04至3.57））。血清脂联素水平可预测∆SHS≥5（aOR = 2.）。血清瘦素水平仅与∆SHS>0独立相关（aOR = 1.59（1.05至2.42））。相反，血清内脂素/NAMPT水平与影像学疾病进展无关。考虑到受试者工作特征曲线，对于∆SHS≥1，最佳脂联素临界值为4.14μg/ml，对于∆SHS≥5为6.04μg/ml，具有良好的特异性（∆SHS≥1和∆SHS≥5时分别为58%和75%）和高阴性预测值（∆SHS≥1或∆SHS≥5时分别为75%和92%）。
血清脂联素水平是一种简单有用的生物标志物，与早期RA的早期影像学疾病进展相关，独立于RA混杂因素和代谢状态。
