Fassio Angelo, Adami Giovanni, Idolazzi Luca, Giollo Alessandro, Viapiana Ombretta, Vantaggiato Elisabetta, Benini Camilla, Rossini Maurizio, Dejaco Christian, Gatti Davide
Rheumatology Unit, University of Verona, Verona, Italy.
Rheumatology Service, South Tyrolean Health Trust, Hospital of Bruneck, Bruneck, Italy.
Front Med (Lausanne). 2020 Sep 9;7:551. doi: 10.3389/fmed.2020.00551. eCollection 2020.
In polymyalgia rheumatica (PMR), data on bone turnover markers (BTM), on Wnt inhibitors (Dkk-1, sclerostin) and their changes induced by glucocorticoids (GC) are lacking. The aims of our study were to compare the baseline levels of Wnt inhibitors and BTM in PMR patients with healthy controls (HC) and to study their changes over the first 4 weeks of GC treatment. We enrolled 17 treatment-naïve patients affected by PMR and 17 age and sex-matched healthy controls (HC) from retired hospital personnel. PMR patients were administered methylprednisolone 16 mg daily for 4 weeks. Blood samples were taken at baseline and at week 4 for the PMR group, a single sample was taken for HC. N-propeptide of type I collagen (PINP), C-terminal telopeptide of type I collagen (CTX-I), sclerostin, Dkk-1, and C-reactive protein (CRP) were dosed. At baseline, Dkk-1 was significantly higher in the PMR group as compared to HC ( = 0.002) while PINP, CTX-I and sclerostin levels were comparable between PMR patients and HC, After 4 weeks of GC treatment we found in the PMR group a decrease of PINP (mean ± SD percentage decrement as compared to baseline -40 ± 18.6%, < 0.001), CTX-I (-23.5 ± 41.3%, = 0.032), Dkk-1 (-22.4 ± 39.6, = 0.033), and sclerostin (-32.49 ± 20.47, < 0.001) as compared to baseline levels. In treatment-naïve PMR, systemic inflammation is associated with a dysregulation of the Wnt system (increased Dkk-1). Within the 1st month, treatment with GC showed noteworthy effects on bone resorption, formation, and on Wnt pathway modulators.
在风湿性多肌痛（PMR）中，缺乏关于骨转换标志物（BTM）、Wnt抑制剂（Dickkopf-1蛋白、硬化蛋白）以及糖皮质激素（GC）诱导的这些指标变化的数据。我们研究的目的是比较PMR患者与健康对照（HC）中Wnt抑制剂和BTM的基线水平，并研究GC治疗前4周内它们的变化。我们纳入了17例初治的PMR患者以及17例年龄和性别匹配的健康对照（来自退休医院工作人员）。PMR患者每天服用16毫克甲泼尼龙，持续4周。在基线时和第4周为PMR组采集血样，为HC组采集单次血样。检测I型胶原N端前肽（PINP）、I型胶原C端肽（CTX-I）、硬化蛋白、Dickkopf-1蛋白（Dkk-1）和C反应蛋白（CRP）。在基线时，与HC相比，PMR组的Dkk-1显著更高（P = 0.002），而PMR患者和HC之间的PINP、CTX-I和硬化蛋白水平相当。GC治疗4周后，我们发现PMR组中PINP（与基线相比平均±标准差百分比下降-40±18.6%，P < 0.001）、CTX-I（-23.5±41.3%，P = 0.032）、Dkk-1（-22.4±39.6，P = 0.033）和硬化蛋白（-32.49±20.47，P < 0.001）与基线水平相比有所下降。在初治的PMR中，全身炎症与Wnt系统失调（Dkk-1增加）有关。在第1个月内，GC治疗对骨吸收、形成以及Wnt通路调节剂显示出显著作用。
