Rheumatology, University Hospital Centre Dijon Bourgogne, Dijon, France
EFS, INSERM, UMR RIGHT, Franche-Comté University, Besançon, France.
RMD Open. 2024 Aug 8;10(3):e004488. doi: 10.1136/rmdopen-2024-004488.
Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are frequently overlapping conditions. Unlike in GCA, vascular inflammation is absent in PMR. Therefore, serum biomarkers reflecting vascular remodelling could be used to identify GCA in cases of apparently isolated PMR.
45 patients with isolated PMR and 29 patients with PMR/GCA overlap were included. Blood samples were collected before starting glucocorticoids for all patients. Serum biomarkers reflecting systemic inflammation (interleukin-6 (IL-6), CXCL9), vascular remodelling (MMP-2, MMP-3, MMP-9) and endothelial function (sCD141, sCD146, ICAM-1, VCAM-1, vWFA2) were measured by Luminex assays.
Patients with GCA had higher serum levels of sCD141 (p=0.002) and CXCL9 (p=0.002) than isolated PMR. By contrast, serum levels of MMP-3 (p=0.01) and IL-6 (p=0.004) were lower in GCA than isolated PMR. The area under the curve (AUC) was calculated for sCD141, CXCL9, IL-6 and MMP-3. Separately, none of them were >0.7, but combinations revealed higher diagnostic accuracy. The CXCL9/IL-6 ratio was significantly increased in patients with GCA (p=0.0001; cut-off >32.8, AUC 0.76), while the MMP-3/sCD141 ratio was significantly lower in patients with GCA (p<0.0001; cut-off <5.3, AUC 0.79). In patients with subclinical GCA, which is the most difficult to diagnose, sCD141 and MMP-3/sCD141 ratio demonstrated high diagnostic accuracy with AUC of 0.81 and 0.77, respectively.
Combined serum biomarkers such as CXCL9/IL-6 and MMP-3/sCD141 could help identify GCA in patients with isolated PMR. It could allow to select patients with PMR in whom complementary examinations are needed.
巨细胞动脉炎（GCA）和多发性肌炎（PMR）经常重叠存在。与 GCA 不同，血管炎症在 PMR 中不存在。因此，反映血管重塑的血清生物标志物可用于识别明显孤立性 PMR 中的 GCA。
共纳入 45 例孤立性 PMR 和 29 例 PMR/GCA 重叠患者。所有患者在开始使用糖皮质激素前均采集血样。通过 Luminex 检测系统测量反映全身炎症（白细胞介素 6（IL-6）、CXCL9）、血管重塑（MMP-2、MMP-3、MMP-9）和内皮功能（sCD141、sCD146、ICAM-1、VCAM-1、vWFA2）的血清标志物。
GCA 患者的 sCD141（p=0.002）和 CXCL9（p=0.002）血清水平高于孤立性 PMR。相比之下，GCA 患者的 MMP-3（p=0.01）和 IL-6（p=0.004）血清水平低于孤立性 PMR。计算了 sCD141、CXCL9、IL-6 和 MMP-3 的曲线下面积（AUC）。单独来看，它们都没有>0.7，但组合显示出更高的诊断准确性。GCA 患者的 CXCL9/IL-6 比值显著升高（p=0.0001；cut-off >32.8，AUC 为 0.76），而 GCA 患者的 MMP-3/sCD141 比值显著降低（p<0.0001；cut-off <5.3，AUC 为 0.79）。在最难以诊断的亚临床 GCA 患者中，sCD141 和 MMP-3/sCD141 比值的 AUC 分别为 0.81 和 0.77，具有较高的诊断准确性。
联合血清生物标志物，如 CXCL9/IL-6 和 MMP-3/sCD141，可以帮助识别孤立性 PMR 中的 GCA。它可以帮助选择需要补充检查的 PMR 患者。
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