Department of Biomedicine, Aarhus University.
Department of Rheumatology, Aarhus University Hospital, Aarhus.
Rheumatology (Oxford). 2022 May 30;61(6):2590-2595. doi: 10.1093/rheumatology/keab763.
Identification of RA patients at a high risk of joint destruction remains challenging. The C-X-C motif chemokine 13 (CXCL13) has previously been suggested as a marker of disease activity in RA. Here, we investigate the potential of plasma CXCL13 as a marker of long-term radiographic status and progression.
CXCL13 was measured in plasma from treatment-naïve RA patients (n = 158) with an 11-year follow-up. At baseline, clinical and biochemical DASs were obtained; among these CRP, ESR, DAS in 28 joints with CRP (DAS28CRP), number of swollen joints (SJC28) and radiographic status, evaluated by total Sharp score (TSS). Age- and gender-matched healthy controls (HCs) were included.
CXCL13 was significantly increased at baseline and decreased during treatment; however, it was not reduced to the level in HCs. At baseline, CXCL13 was associated with both CRP and ESR, but not with other markers of disease activity. Baseline CXCL13 was correlated with both TSS and radiographic progression (ΔTSS) at 11 years. With an 89% probability, levels of CXCL13 above 85 pg/ml predicted the risk of a TSS of 5 or above, after 11 years of treatment. Compared with CRP, DAS28CRP, SJC28 and ACPA status, CXCL13 was superior in predicting 11-year joint destruction.
In early RA, one single measurement of plasma CXCL13 at baseline is superior to currently used clinical and serological disease markers in the prediction of long-term radiographic status and progression.
RA 患者发生关节破坏的高风险仍然难以识别。趋化因子（C-X-C 基序）配体 13（CXCL13）先前被认为是 RA 疾病活动的标志物。本研究旨在探究血浆 CXCL13 作为长期影像学结果和进展的预测标志物的潜力。
对 158 例未经治疗的 RA 患者进行了为期 11 年的随访，检测其血浆中 CXCL13 的浓度。在基线时，评估了临床和生物化学 DAS 评分；其中包括 CRP、ESR、基于 CRP 的 28 关节 DAS（DAS28CRP）、肿胀关节数（SJC28）和影像学状态，采用总 Sharp 评分（TSS）进行评估。纳入年龄和性别匹配的健康对照者（HCs）作为对照。
基线时 CXCL13 显著升高，治疗过程中逐渐降低，但未降至 HCs 水平。基线时，CXCL13 与 CRP 和 ESR 相关，但与其他疾病活动标志物无关。基线 CXCL13 与 11 年后的 TSS 和影像学进展（ΔTSS）均相关。CXCL13 水平超过 85pg/ml 时，有 89%的概率预测 11 年后 TSS 为 5 或以上。与 CRP、DAS28CRP、SJC28 和 ACPA 状态相比，CXCL13 更能预测 11 年的关节破坏。
在早期 RA 中，基线时单次检测血浆 CXCL13 优于目前用于预测长期影像学结果和进展的临床和血清学疾病标志物。
