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SILJE W. SYVERSEN, GURO L. GOLL, DÉSIRÉE van der HEIJDE, ROBERT LANDEWÉ, PER IVAR GAARDER, SIGRID ØDEGÅRD, ESPEN A. HAAVARDSHOLM, and TORE K. KVIEN ABSTRACT. Objective. As current predictors of joint destruction have low specificity, serological biomarkers reflecting bone and cartilage destruction have been proposed as tools in assessing prognosis of rheumatoid arthritis (RA). We examined whether serum concentrations of a panel of biomarkers could predict radiographic progression in patients with RA. Methods. A cohort of 238 patients with RA was followed longitudinally for 10 years with collection of clinical data and serum samples. These analyses focus on the 136 patients with radiographs of the hands available at baseline and at 5 and/or 10 years. Radiographs were scored according to the van der Heijde-modified Sharp score (SHS). Baseline sera were analyzed for receptor activator of nuclear factor-kB ligand (RANKL), osteoprotegerin (OPG), human cartilage glycoprotein-39 (YKL-40), C2C, collagen cross-linked C-telopeptide (CTX-I), and cartilage oligomeric matrix protein (COMP). Multivariate linear and logistic regression analyses were used to identify predictors of radiographic progression. Results. Baseline CTX-I levels were higher in progressors [0.41 ng/ml (interquartile range 0.31–0.75)] than in nonprogressors [0.32 ng/ml (IQR 0.21–0.49)], and were independently associated with 10-year change in radiographic damage score [ß = 16.4 (IQR 5.7–27.1)]. We found no association between radiographic progression and baseline serum levels of RANKL, OPG, C2C, YKL-40, or COMP. Conclusion. This longterm followup study of patients with RA indicates a relationship between elevated CTX-I levels in serum and subsequent joint destruction. This association was, however, weak, and our study does not support that serum CTX-I or any of the other tested biomarkers will serve as more useful prognostic markers than current predictors such as anti-cyclic citrullinated peptide, radiographic damage early in the disease course, and signs of inflammation. (J Rheumatol First Release Dec 15 2008; doi:10.3899/jrheum.080180) Key Indexing Terms: RHEUMATOID ARTHRITIS BIOMARKER RADIOGRAPHIC PROGRESSION PROGNOSIS CTX-I From the Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Immunology and Transfusion Medicine, University Hospital Ullevål, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Rheumatology, University Hospital Maastricht, Maastricht, The Netherlands; and Faculty of Medicine, University of Oslo, Oslo, Norway. Supported by grants from the Eastern Norway Regional Health Authority, the Norwegian Foundation for Health and Rehabilitation, and the Norwegian Women’s Public Health Association. S.W. Syversen, MD, Department of Rheumatology, Diakonhjemmet Hospital, Faculty of Medicine, University of Oslo; G.L. Goll, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Department of Rheumatology, Leiden University Medical Center; R. Landewé, MD, PhD, Department of Rheumatology, University Hospital Maastricht; P.I. Gaarder, MD, PhD, Department of Immunology and Transfusion Medicine, University Hospital Ullevål; S. Ødegård, MD; E.A. Haavardsholm, MD; T.K. Kvien, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Faculty of Medicine, University of Oslo. Address reprint requests to Dr. S.W. Syversen, Department of Rheumatology, Diakonhjemmet Hospital, Box 23, Vinderen, N-0319 Oslo, Norway. E-mail: s.w.syversen@medisin.uio.no Accepted for publication September 14, 2008. |
