The Clinic of Rheumatology, Traumatology Orthopaedics and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio str. 21, 03101 Vilnius, Lithuania.
State Research Institute Centre for Innovative Medicine, Santariškių g. 5, 08406 Vilnius, Lithuania.
Medicina (Kaunas). 2022 Jun 20;58(6):833. doi: 10.3390/medicina58060833.
Background and Objectives: Early undifferentiated arthritis (UA) is a group of inflammatory joint diseases that are not classified under any specific rheumatic or connective tissue disorder and might evolve into chronic inflammatory arthritis or may be a self-limiting condition. Early recognition and treatment are crucial for the future course of the disease. Vascular endothelial growth factor (VEGF) is an angiogenic regulator that induces the growth of new capillary blood vessels, which are important in joint invasion and destruction during the progression of chronic inflammatory arthritis. The aim of this study was to assess VEGF levels associated with sociodemographic, clinical, laboratory, and ultrasound findings in the early UA patient cohort as well as to evaluate VEGF as a potential prognostic marker for arthritis outcomes. Materials and Methods: Seventy-six patients with inflammatory arthritis in at least one joint, with a duration of arthritis <12 months at the study entry that did not meet any rheumatic disease classification criteria, were enrolled after informed consent was obtained. Patient’s sociodemographic, laboratory data, and clinical disease characteristics were recorded, VEGF levels were measured, and ultrasound (US) of tender and swollen joints was performed. Results: VEGF levels had positive correlation with conventional rheumatic disease activity and diagnostic markers: erythrocyte sedimentation rate (ESR), C−reactive protein (CRP), and rheumatoid factor (RF) (p < 0.05). RF-positive patients had higher VEGF values (p = 0.024). A statistically higher number of patients whose VEGF levels were below the median value presented with active infection (p = 0.046). In patients with a higher number of swollen joints, and a higher score of synovitis and power doppler (PD) seen on US, VEGF levels were statistically significantly higher. Patients who after 12-month follow-up developed rheumatoid arthritis (RA) had statistically higher VEGF levels at baseline compared with those who developed spondyloarthropathies (p = 0.028). Conclusions: This study demonstrated that VEGF levels significantly represented inflammatory processes that were present in the joints (number of swollen joints, synovitis, and PD changes) of the early UA cohort.
早期未分化关节炎（UA）是一组未归入任何特定风湿或结缔组织疾病类别的炎性关节疾病，可能发展为慢性炎性关节炎，也可能是自限性疾病。早期识别和治疗对于疾病的未来进程至关重要。血管内皮生长因子（VEGF）是一种血管生成调节剂，可诱导新毛细血管的生长，这对于慢性炎性关节炎进展过程中关节的侵袭和破坏很重要。本研究旨在评估早期 UA 患者队列中与社会人口统计学、临床、实验室和超声发现相关的 VEGF 水平，并评估 VEGF 作为关节炎结局的潜在预后标志物。
在获得知情同意后，共纳入 76 例至少有一个关节炎症且关节炎病程<12 个月的炎症性关节炎患者，这些患者不符合任何风湿性疾病分类标准。记录患者的社会人口统计学、实验室数据和临床疾病特征，测量 VEGF 水平，并对压痛和肿胀关节进行超声检查。
VEGF 水平与常规风湿性疾病活动度和诊断标志物呈正相关：红细胞沉降率（ESR）、C 反应蛋白（CRP）和类风湿因子（RF）（p<0.05）。RF 阳性患者的 VEGF 值更高（p=0.024）。统计学上，VEGF 值低于中位数的患者更易出现活动性感染（p=0.046）。在 VEGF 水平较高的患者中，肿胀关节较多，超声检查显示滑膜炎和功率多普勒（PD）评分较高，VEGF 水平也明显更高。在随访 12 个月后发展为类风湿关节炎（RA）的患者，其基线 VEGF 水平明显高于发展为脊柱关节病的患者（p=0.028）。
本研究表明，VEGF 水平显著代表了早期 UA 队列关节（肿胀关节数、滑膜炎和 PD 变化）中存在的炎症过程。
