Department of Rheumatology, Cochin Hospital and Epidemiology and Biostatistics Unit, Sorbonne Paris Cite Research Center, Paris Descartes University, INSERM U1153, Paris, France.
Department of Biology, Cochin Hospital, Paris Descartes University, INSERM U1153, Paris, France.
Rheumatology (Oxford). 2021 Mar 2;60(3):1185-1194. doi: 10.1093/rheumatology/keaa296.
The hallmark of advanced axial SpA (axSpA) is spine ankylosis due to excessive ectopic bone formation. This prospective study aimed to describe the changes in serum levels of different regulators [sclerostin, dickkopf-1 (DKK-1)] and markers of bone formation [bone morphogenetic protein 7 (BMP-7)] over 5 years in early axSpA patients and to assess determinants of such changes.
The DEvenir des Spondyloarthropathies Indifférenciées Récentes cohort is a prospective, multicentre French study of 708 patients with early (>3 months-<3 years) inflammatory back pain suggestive of axSpA. Serum levels of BMP-7, sclerostin and DKK-1 were assessed at baseline and after 2 and 5 years. Changes in bone formation regulators over time were analysed using mixed linear models.
Serum BMP-7 significantly increased over time, with a median relative change of 223.7% [interquartile range (IQR) 0-10 700 (0.17 pg/ml/month), P < 0.001]. Serum sclerostin significantly increased over time, with a median relative change of 14.8% [IQR -7.9-41.4% (0.001 ng/ml/month), P < 0.001]. Serum DKK-1 did not significantly change over time. Serum BMP-7 increased over time in active disease (Ankylosing Spondylitis Disease Activity Score with CRP ≥1.3, P = 0.01), but the increase was less pronounced with TNF inhibitor (TNFi) use (P < 0.001). No determinant was associated with serum sclerostin change.
Serum BMP-7 change over 5 years was related with inflammation; it was increased in active disease, but the increase was low with TNFi use. Serum sclerostin levels significantly increased over time, but to a lesser degree than for serum BMP-7.
https://clinicaltrials.gov/, NCT01648907.
中轴型脊柱关节炎（axSpA）的主要特征是由于异位骨形成过多导致脊柱强直。本前瞻性研究旨在描述早期 axSpA 患者在 5 年内不同调节因子[骨硬化蛋白、Dickkopf-1（DKK-1）]和骨形成标志物[骨形态发生蛋白 7（BMP-7）]的血清水平变化，并评估这些变化的决定因素。
DEvenir des Spondyloarthropathies Indifférenciées Récentes 队列是一项前瞻性、多中心的法国研究，纳入了 708 例早期（>3 个月至<3 年）炎症性背痛疑似 axSpA 的患者。在基线时以及 2 年和 5 年后评估了 BMP-7、骨硬化蛋白和 DKK-1 的血清水平。使用混合线性模型分析了随时间变化的骨形成调节剂的变化。
血清 BMP-7 随时间显著增加，中位数相对变化为 223.7%[四分位距（IQR）0-10700（0.17pg/ml/月），P<0.001]。血清骨硬化蛋白随时间显著增加，中位数相对变化为 14.8%[IQR -7.9-41.4%（0.001ng/ml/月），P<0.001]。血清 DKK-1 随时间无显著变化。在活动性疾病（C 反应蛋白≥1.3 的强直性脊柱炎疾病活动评分）中，血清 BMP-7 随时间增加（P=0.01），但 TNF 抑制剂（TNFi）使用时增加幅度较小（P<0.001）。没有决定因素与血清骨硬化蛋白变化相关。
5 年内血清 BMP-7 的变化与炎症有关；在活动性疾病中增加，但 TNFi 使用时增加幅度较小。血清骨硬化蛋白水平随时间显著增加，但增加幅度小于血清 BMP-7。
