Serological Bone Markers and Joint Damage in Early Polyarthritis

LOUISE M.A. JANSEN, IRENE E. van der HORST-BRUINSMA, WILLEM F. LEMS, DIRKJAN van SCHAARDENBURG, ROB J. van de STADT, MARGRET H.M.T. de KONING, and BEN A.C. DIJKMANS

ABSTRACT.

Objective. To investigate the relationship between osteocalcin (OC), a marker of bone formation, and the recently developed serum marker of bone resorption, ß-C-telopeptide (ß-CTx), and radiographic damage in patients with early oligo- and polyarthritis.

Methods. Patients with peripheral arthritis of ≥ 2 joints and < 2 years of symptom duration were studied. The OC and ß-CTx concentrations at baseline were correlated with disease activity and radiographic damage at baseline, and with radiographic progressive disease after 2 years (delta Sharp/van der Heijde score ≥ 5). The additional value of serum bone metabolism markers to predict radiographic progressive disease was compared to that of established prognostic factors by multivariate logistic regression analysis.

Results. Two hundred seventy-nine patients (67% female; median age 56 yrs, range 18–83) were included in the study, of whom 73% were diagnosed with rheumatoid arthritis (RA). Baseline levels of ß-CTx (p < 0.05) were significantly correlated with baseline radiographic damage whereas OC was not. ß-CTx was also significantly (p < 0.001) related to measures of disease activity like erythrocyte sedimentation rate, C-reactive protein, and the disease activity score DAS28. Radiographic progressive disease after 2 years corresponded univariately with increased levels of ß-CTx (p < 0.001), but not with OC. In multivariate analysis, ß-CTx was not superior to other measures of radiographic progressive disease such as autoantibodies and disease activity.

Conclusion. Increased serum levels of the bone turnover marker ß-CTx are associated with radiographic damage at baseline and radiographic progression after 2 years. However, ß-CTX is less predictive than markers already in use. (J Rheumatol 2004;31:1491-6)

Key Indexing Terms:

BONE TURNOVER MARKERS
JOINT DAMAGE
EARLY POLYARTHRITIS

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From the Jan van Breemen Instituut and the Department of Rheumatology, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands.

L.M.A. Jansen, PhD; D. van Schaardenburg, MD, PhD; R.J. van de Stadt, PhD; M.H.M.T. de Koning, Technician, Jan van Breemen Instituut; I.E. van der Horst-Bruinsma, MD, PhD; W.F. Lems, MD, PhD; B.A.C. Dijkmans, MD, PhD, Department of Rheumatology, Vrije Universiteit Medical Centre.

Address reprint requests to Dr. B.A.C. Dijkmans, Vrije Universiteit Medical Centre, Department of Rheumatology, PO Box 7057, 1007 MB Amsterdam, The Netherlands. E-mail: secr.reumatologie@vumc.nl

Submitted May 16, 2003; revision accepted February 11, 2004.

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