Abstract
Joint destruction in juvenile idiopathic arthritis (JIA), initiated in the early, preclinical stage of the disease, is diagnosed on the basis of clinical evaluation and radiographic imaging. The determination of circulating cartilage-matrix turnover markers can facilitate the diagnosis and application of better and earlier treatment strategies for JIA. We have shown that 96 JIA patients have elevated levels of procollagen II C-terminal propeptide (PIICP), reflecting the extent of joint cartilage biosynthesis, and C-telopeptide of type II collagen (CTXII), a biomarker of the resorption of this tissue. Patients who did not respond to treatment had particularly high levels of these markers. JIA treatment resulted in the normalization of these markers in remissive patients, but not in those with active JIA. We showed correlations between examined variables and inflammatory process indicators, i.e., C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and tumor necrosis factor-α (TNF-α). The TNF-α of patients responding to treatment correlated with PIICP, especially in the patients before treatment (r = 0.898, p < 0.001). Significant changes in serum PIICP during JIA therapy suggest its potential diagnostic utility in the monitoring of disease activity and the possibility of its use in assessing treatment towards remission. Understanding changes in type II collagen metabolism over the course of the discussed arthritis may allow the implementation of both new diagnostic tools and new therapeutic strategies in children with JIA.
Highlights
The term juvenile idiopathic arthritis (JIA) defines a heterogeneous collection of autoimmune or autoinflammatory rheumatic diseases, with onset before the age of 16 years.There is no specific symptom or examination findings for JIA, and diagnosis is made by exclusion and differentiation [1,2,3]
It was observed that the therapy modifying the course of inflammation, which was administered to JIA patients, and contributing to clinical improvement, resulted in a significant decrease (p = 0.0000, by 37%) in serum levels of procollagen II C-terminal propeptide (PIICP) in patients with inactive
We have shown a significant increase in the serum concentration of both PIICP, which is an indicator of the Analyzing the strength of the relation between CTXII and tumor necrosis factor-α (TNF-α), a relationship described by the Pearson correlation coefficient r = 0.410 (p = 0.0005) between these variables was demonstrated in patients from the B’ subgroup, i.e., treated patients who did not achieve clinical improvement
Summary
The term juvenile idiopathic arthritis (JIA) defines a heterogeneous collection of autoimmune or autoinflammatory rheumatic diseases, with onset before the age of 16 years.There is no specific symptom or examination findings for JIA, and diagnosis is made by exclusion and differentiation [1,2,3]. JIA that is poorly treated or diagnosed too late may contribute to the disability of an afflicted child, due to disturbances in the structure and function of the osteoarticular system. These disorders are attributed to changes in the homeostasis of extracellular matrix (ECM) components, of which the cartilage is composed [4,5,6]. The cartilaginous extracellular matrix is a multicomponent, ordered, flexible network structure that fills the spaces between chondrocytes [7,8]. Mentioned collagen fibrils provide cartilage with tensile strength and contribute to the physical properties of the mature matrix.
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