Abstract
Objectives: The study aimed to evaluate biomarkers facilitating early axial-spondyloarthritis (axSpA) diagnosis and disease activity and imaging indices correlated.Materials and Methods: Seventy-five patients with low back pain (LBP) (≥3 months, ≤2 years, onset ≤45 years) participating in the Italian arm of the SpondyloArthritis-Caught-Early (SPACE) study underwent a physical examination, questionnaires, laboratory tests, spine, and sacroiliac joints (SIJ) X-rays and magnetic resonance imaging (MRI) at baseline and during a 24-months follow-up. Two expert rheumatologists formulated axSpA diagnosis and assessed fulfillment of Assessment of SpondyloArthritis International Society (ASAS) criteria. Disease activity and physical functioning were assessed using imaging, clinical, and serological indices. Spine and SIJ MRI and X-rays were scored independently by 2 readers following the Spondyloarthritis Research Consortium of Canada (SPARCC), mSASSS, and mNY-criteria. Patients were classified in accordance to ASAS criteria as: 21 patients classified according to axSpA imaging arm; 29 patients classified according to axSpA clinical ± imaging arm; 25 patients not fulfilling ASAS criteria.Results: At baseline biomarker levels were not significantly increased in any of the patient groups. Instead, a significant decrease of all functional and disease activity indices from baseline to 24 months was observed in all the three groups. In the same period, there were no significant variation in the serological markers values within each group. The correlations between IL-17 and IL-23 and clinical and functional indices were not significant. On the other hand, significant correlations were found between IL-22 and Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Patient Global Score (BASG1), Health Assessment Questionnaire (HAQ), Visual Analog Scale (VAS pain); MMP3 and mSASSS; MMP3 and hsCRP.Conclusions: Although not significantly higher in any of the cohorts, IL-22, MMP3, and hsCRP values correlated with some disease activity indices and with mSASSS. Further studies are warranted to confirm these preliminary findings.
Highlights
Spondyloarthritis (SpA) is a group of debilitating, chronic, rheumatic diseases characterized by overlapping clinical signs and symptoms and a common genetic background [1]
magnetic resonance imaging (MRI) images were analyzed in accordance with the Assessment of SpondyloArthritis International Society (ASAS)/OMERACT criteria [6, 18] and the Spondyloarthritis Research Consortium of Canada (SPARCC) score [19, 20], while spine X-Rays and sacroiliac joints (SIJ) X-Rays were scored in accordance with the Stoke Ankylosing Spondylitis Spinal Score (SASSS) system modified by Creemers [21] and mNY criteria [22]
In our study we found an interesting correlation between Erythrocyte sedimentation rate (ESR) and clinical indices and mSASSS, C-reactive protein (CRP) currently appears to be a reliable biomarker for assessing disease activity and predicting structural progression and treatment response and ESR appears to be a non-specific measure of inflammation that may be influenced by a variety of other non-rheumatic conditions and comorbidities
Summary
Spondyloarthritis (SpA) is a group of debilitating, chronic, rheumatic diseases characterized by overlapping clinical signs and symptoms and a common genetic background [1]. Recent studies have focused on the role of some new markers in diagnosing early axSpA, assessing disease activity and identifying patients at higher risk for a worse outcome [7, 8, 10,11,12]. Serum and plasma biomarkers have recently undergone extensive examination and while Human Leukocyte Antigen (HLA-B27), the biomarker commonly used in SpA remains relevant, other biomarkers for systemic inflammation such as C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR), usually used in clinical practice, are often unable to assess disease activity in axSpA [13,14,15,16]. As early treatment can reduce the disease burden in axSpA patients and disease-related costs, uncovering biomarkers that can help early diagnosis of axSpA has become an urgent undertaking
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