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  • Serum inflammatory biomarkers fail to identify early axial spondyloarthritis: results from the SpondyloArthritis Caught Early (SPACE) cohort

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Spondyloarthritis
Original article
Serum inflammatory biomarkers fail to identify early axial spondyloarthritis: results from the SpondyloArthritis Caught Early (SPACE) cohort
  1. Maureen C Turina1,
  2. Nataliya Yeremenko1,2,
  3. Floris van Gaalen3,
  4. Maikel van Oosterhout4,
  5. Inger J Berg5,
  6. Ramona Ramonda6,
  7. Cristina (M C) Lebre2,
  8. Robert Landewé1 and
  9. Dominique Baeten1,2
  1. 1Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
  2. 2Department of Experimental Immunology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
  3. 3Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  4. 4Department of Rheumatology, Groene Hart Ziekenhuis, Gouda, The Netherlands
  5. 5Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  6. 6Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
  1. Correspondence to Professor Dominique Baeten; d.l.baeten{at}amc.uva.nl

Abstract

Introduction Decreasing the diagnostic delay in axial spondyloarthritis (axSpA) remains a major challenge. Here, we assessed the value of serum inflammatory biomarkers to distinguish early axSpA from other pathologies in a large cohort of patients referred with early back pain.

Methods Serum c reactive protein (CRP), erythrocyte sedimentation rate (ESR) and calprotectin were determined in the SPondyloArthritis Caught Early (SPACE) cohort (n=310), an early back pain inception cohort. Additionally, explorative serum biomarkers derived from the literature (interleukin-27 (IL-27), human β-defensin-2 (hBD-2) and lipcolin-2 (LCN-2)) were determined by ELISA in full-blown patients with ankylosing spondylitis (AS) (n=21) and healthy controls (n=20).

Results Serum CRP and ESR levels were not elevated in early axSpA versus ‘control’ back pain patients. Serum calprotectin was elevated in early axSpA versus controls (p=0.01) but failed to identify early axSpA at the individual level (positive predictive value of 38.7%). As to explorative biomarkers, serum levels of IL-27 were not detectable, and hBD-2 and LCN-2 serum levels were not elevated in full-blown AS versus healthy controls (p=0.572, p=0.562, respectively). Therefore, these markers were not further determined in the SPACE cohort.

Conclusions None of the candidate serum inflammatory markers were useful as diagnostic markers in the early phase of axSpA.

  • Spondyloarthritis
  • Inflammation
  • Low Back Pain

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2016-000319

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    Footnotes

    • Contributors MT, NY and DB were involved in study concept and design. MT, NY, FvG, MvO, IB and ML acquired the data. MT, NY, FvG, MvO, IB, RR, ML, RL and DB were involved in analysis and interpretation of data. All authors were involved in drafting the article or revising it critically for important intellectual content and all authors approved the final version to be published.

    • Competing interests MCT was supported by an unrestricted fellowship from Janssen and DB was supported by a VICI grant from The Netherlands Organization for Scientific Research (NWO), by a Consolidator Grant from the European Research Council (ERC), and by a grant from the Dutch Arthritis Foundation (Reumafonds). NY, FvG, MvO, IJB, RR, CL and RL have no conflict of interests.

    • Patient consent Obtained.

    • Ethics approval LUMC, AMC, Regional Committee for Medical and Health Research Ethics (Oslo, Norway).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.