Early increase in serum-COMP is associated with joint damage progression over the first five years in patients with rheumatoid arthritis.
Early increase in serum-COMP is associated with joint damage progression over the first five years in patients with rheumatoid arthritis.
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DOI：
10.1186/1471-2474-14-229
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发表时间：
2013-08-02
影响因子：
2.3
通讯作者：
Saxne T
中科院分区：
文献类型：
--
作者：
Andersson ML;Svensson B;Petersson IF;Hafström I;Albertsson K;Forslind K;Heinegård D;Saxne T
目前可用于类风湿性关节炎中导致关节损伤的早期组织过程的生物标志物是不足的，并且缺乏预后准确性，这可能是疾病随时间变化的活动的结果。这项研究代表了一种新的方法来检测疾病过程的活性改变，检测为在短时间内增加血清COMP水平，以及这是否与疾病前5年的关节损伤进展相关。在瑞典的BARFOT早期RA研究中，共有349例患者接受了检查。在诊断时和3个月后通过ELISA分析血清COMP。根据血清COMP水平的变化，将患者分为三个亚组：水平不变（变化≤ 20%）（N=142）、水平降低（> 20%）（N=173）和水平升高（> 20%）（N=34）。在入选时、1年、2年和5年后获得手和脚的X线片，并根据Sharp货车der Heijde（SHS）进行评分。影像学进展定义为SHS增加≥5.8。与COMP水平稳定或降低的组相比，COMP水平升高的患者组在1年、2年和5年随访时总SHS和糜烂评分的中位变化更高。此外，COMP水平升高的患者与COMP水平不变的患者相比，放射学进展的比值比为2.8（95% CI 1.26-6.38）。COMP水平升高的患者组在入选时具有较高的ESR，但各组之间的年龄、性别、疾病持续时间、疾病活动度（DAS 28）、功能（HAQ）、CRP以及类风湿因子或抗-CCP的存在均无基线差异。重要的是，DAS 28、HAQ、ESR和CRP在3个月期间的变化在组间也没有差异，这些变量与关节损伤进展无关。早期RA患者在诊断和随后3个月之间血清COMP水平的增加代表了关节中激活破坏性过程的新指标，并且是识别5年期间关节损伤进展显著的患者的有希望的工具。
Currently available biomarkers for the early tissue process leading to joint damage in rheumatoid arthritis are insufficient and lack prognostic accuracy, possibly a result of variable activity of the disease over time. This study represents a novel approach to detect an altered activity of the disease process detected as increasing serum-COMP levels over a short time and whether this would correlate with joint damage progression over the first 5 years of disease. In all, 349 patients from the Swedish BARFOT early RA study were examined. Serum-COMP was analysed by ELISA at diagnosis and after 3 months. Based on changes in serum-COMP levels, three subgroups of patients were defined: those with unchanged levels (change ≤ 20%) (N=142), decreasing levels (> 20%) (N=173) and increasing levels (> 20%) (N=34). Radiographs of hands and feet were obtained at inclusion, after 1, 2 and 5 years and scored according to Sharp van der Heijde (SHS). Radiographic progression was defined as increase in SHS by ≥5.8. The group of patients with increasing COMP levels showed higher median change in total SHS and erosion scores at 1, 2 and 5 year follow-up compared with the groups with stable or decreasing COMP levels. Furthermore, the odds ratio of radiographic progression was 2.8 (95% CI 1.26-6.38) for patients with increasing COMP levels vs. patients with unchanged levels. The group of patients with increasing COMP levels had higher ESR at inclusion but there were no baseline differences between the groups for age, gender, disease duration, disease activity (DAS28), function (HAQ), CRP, nor presence of rheumatoid factor or anti-CCP. Importantly, neither did changes over the 3-month period in DAS28, HAQ, ESR nor CRP differ between the groups and these variables did not correlate to joint damage progression. Increasing serum-COMP levels between diagnosis and the subsequent 3 months in patients with early RA represents a novel indicator of an activated destructive process in the joint and is a promising tool to identify patients with significant joint damage progression during a 5-year period.
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