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JIN-HYUN WOO, HYUN-JOO LEE, IL-HOON SUNG, and TAE-HWAN KIM

ABSTRACT.

Objective. Tumor necrosis factor-a has a prominent role in the inflammatory process and bone resorption in patients with ankylosing spondylitis (AS). We evaluated the markers of clinical efficacy and bone biochemical changes in Korean patients with AS treated with etanercept therapy.

Methods. Serum samples from 26 patients receiving etanercept for refractory AS were obtained at baseline and 12 weeks after treatment. Clinical measures and serum levels of transforming growth factor-ß (TGF-ß), matrix metalloproteinase-3 (MMP-3), macrophage-colony stimulating factor (M-CSF), bone-specific alkaline phosphatase (BALP), osteocalcin, C-telopeptide (CTX), receptor activator of nuclear factor-kB ligand (RANKL), and osteoprotegerin (OPG) were measured at each timepoint.

Results. Significant improvement of the Bath AS Disease Activity Index (BASDAI) and Functional Index (BASFI) was achieved after 12 weeks (p < 0.001). ASsessments in Ankylosing Spondylitis Working Group (ASAS) 20 criteria were achieved by 22 patients (84.6%) after 12 weeks' treatment. ASAS 50 and 70 were achieved by 10 (38.5%) and 7 patients (26.9%). Serum levels of BALP and osteocalcin were significantly increased after 12 weeks of treatment (p < 0.05). Serum levels of CTX were not changed after treatment. Serum levels of TGF-ß, MMP-3, and M-CSF were significantly decreased after 12 weeks of treatment (p < 0.05). Serum levels of OPG and RANKL were not changed. Change of MMP-3 had a high correlation coefficient with changes of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) upon etanercept treatment (CRP, r = 0.446, p = 0.022; ESR, r = 0.449, p = 0.021).

Conclusion. In patients with AS, etanercept therapy may be effective for reducing disease activity and improving bone biochemical markers. MMP-3 may be a useful biomarker for monitoring etanercept therapy. (First Release June 15 2007; J Rheumatol 2007;34:1753-9)

Key Indexing Terms:

ANKYLOSING SPONDYLITIS
BONE BIOCHEMICAL MARKER
ETANERCEPT

From the Division of Rheumatology, the Hospital for Rheumatic Diseases; and The Institute of Rheumatism, Hanyang University, Seoul, Korea.

J-H. Woo, MD, PhD, Instructor, Division of Rheumatology, Department of Internal Medicine, Korea University Medical Center, Korea University College of Medicine; T-H. Kim, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, the Hospital for Rheumatic Diseases; H-J. Lee, MS, The Institute of Rheumatism; I-H. Sung, MD, PhD, Associate Professor, Department of Orthopedic Surgery, Hanyang University.

Address reprint requests to Dr. T-H. Kim, Division of Rheumatology, The Hospital for Rheumatic Diseases, Hanyang University, Seoul 133-792, Korea. E-mail: thkim@hanyang.ac.kr

Accepted for publication March 15, 2007.