Arthritis instantaneously causes collagen type I and type II degradation in patients with early rheumatoid arthritis:: a longitudinal analysis
Arthritis instantaneously causes collagen type I and type II degradation in patients with early rheumatoid arthritis:: a longitudinal analysis
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DOI：
10.1136/ard.2004.035196
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发表时间：
2006-01-01
影响因子：
27.4
通讯作者：
Garnero, P
中科院分区：
文献类型：
--
作者：
Landewé, RBM;Geusens, P;Garnero, P
背景：ⅰ型胶原（CTX-I）和ⅱ型胶原（CTX-II）降解标志物，反映骨和软骨的破坏，似乎可以预测慢性持续性关节炎的长期影像学进展。目的：纵向分析关节炎严重程度的变化是否与CTX-I和CTX-II降解水平的直接变化有关。方法：在基线和治疗开始后3、6、9和12个月，对105例参加COBRA试验的早期类风湿关节炎患者的尿液样本中CTX-I和CTX-II进行测量。通过一阶自回归的广义估计方程（GEE），将生物标志物随时间的变化过程与同一时间点测量的ESR、肿胀和压痛关节计数和28个关节疾病活动评分（DAS28）的过程进行比较，并对类风湿因子、治疗和基线放射学损伤进行调整。结果：GEE显示CTX-I与DAS28纵向相关，但与ESR、肿胀关节计数或压痛关节计数无关。然而，CTX-II与ESR、肿胀关节计数和DAS28纵向相关，但与压痛关节计数无关。纵向关联表明，关节炎程度的增加立即伴随着II型胶原蛋白降解的增加，而I型胶原蛋白降解的程度较小。结论：CTX-II测量的软骨退化和CTX-I测量的较小程度的骨退化与关节炎指标密切相关。临床上可察觉的关节炎是造成直接损害的原因，这在x光平片上只有很久以后才能看到。
Background: Markers of collagen type I (CTX-I) and type II (CTX-II) degradation, reflecting bone and cartilage breakdown, appear to predict long term radiographic progression in chronic persistent arthritis.Objective: To analyse longitudinally whether changes in arthritis severity are linked to immediate changes in the level of CTX-I and CTX-II degradation.Methods: CTX-I and CTX-II were measured in urine samples from 105 patients with early rheumatoid arthritis who had participated in the COBRA trial at baseline and at 3, 6, 9, and 12 months after the start of treatment. The course of the biomarkers over time was compared with the course of ESR, swollen and tender joint counts, and 28 joint disease activity score (DAS28), measured at the same time points, with adjustment for rheumatoid factor, treatment, and baseline radiographic damage, by generalised estimating equations (GEE) with first order autoregression.Results: GEE showed that CTX-I was longitudinally associated with DAS28, but not with ESR, swollen joint count, or tender joint count. CTX-II, however, was longitudinally associated with ESR, swollen joint count and DAS28, but not with tender joint count. The longitudinal association implies that an increase in the extent of arthritis is immediately followed by an increase in collagen type II degradation, and to a lesser extent collagen type I degradation.Conclusions: Cartilage degradation as measured by CTX-II and to a lesser extent bone degradation as measured by CTX-I closely follows indices of arthritis. Clinically perceptible arthritis is responsible for immediate damage, which will become visible on plain x rays only much later.