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Early increase in serum-COMP is associated with joint damage progression over the first five years in patients with rheumatoid arthritis.

Andersson ML, Svensson B, Petersson IF, Hafström I, Albertsson K, Forslind K, Heinegård D, Saxne T - BMC Musculoskelet Disord (2013)

Bottom Line: Radiographic progression was defined as increase in SHS by ≥5.8.The group of patients with increasing COMP levels showed higher median change in total SHS and erosion scores at 1, 2 and 5 year follow-up compared with the groups with stable or decreasing COMP levels.Importantly, neither did changes over the 3-month period in DAS28, HAQ, ESR nor CRP differ between the groups and these variables did not correlate to joint damage progression.

View Article: PubMed Central - HTML - PubMed

Affiliation: R and D center, Spenshult Hospital, Oskarström, Sweden. maria.andersson@spenshult.se

ABSTRACT

Background: Currently available biomarkers for the early tissue process leading to joint damage in rheumatoid arthritis are insufficient and lack prognostic accuracy, possibly a result of variable activity of the disease over time. This study represents a novel approach to detect an altered activity of the disease process detected as increasing serum-COMP levels over a short time and whether this would correlate with joint damage progression over the first 5 years of disease.

Methods: In all, 349 patients from the Swedish BARFOT early RA study were examined. Serum-COMP was analysed by ELISA at diagnosis and after 3 months. Based on changes in serum-COMP levels, three subgroups of patients were defined: those with unchanged levels (change ≤ 20%) (N=142), decreasing levels (> 20%) (N=173) and increasing levels (> 20%) (N=34). Radiographs of hands and feet were obtained at inclusion, after 1, 2 and 5 years and scored according to Sharp van der Heijde (SHS). Radiographic progression was defined as increase in SHS by ≥5.8.

Results: The group of patients with increasing COMP levels showed higher median change in total SHS and erosion scores at 1, 2 and 5 year follow-up compared with the groups with stable or decreasing COMP levels. Furthermore, the odds ratio of radiographic progression was 2.8 (95% CI 1.26-6.38) for patients with increasing COMP levels vs. patients with unchanged levels.The group of patients with increasing COMP levels had higher ESR at inclusion but there were no baseline differences between the groups for age, gender, disease duration, disease activity (DAS28), function (HAQ), CRP, nor presence of rheumatoid factor or anti-CCP. Importantly, neither did changes over the 3-month period in DAS28, HAQ, ESR nor CRP differ between the groups and these variables did not correlate to joint damage progression.

Conclusion: Increasing serum-COMP levels between diagnosis and the subsequent 3 months in patients with early RA represents a novel indicator of an activated destructive process in the joint and is a promising tool to identify patients with significant joint damage progression during a 5-year period.

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Median change of erosion score (A), joint space narrowing (JSN) (B) and total Sharp van der Heijde score (SHS) (C) between inclusion and the 1, 2 and 5 year examinations. Figure 2 shows median change with 75% CI (denoted by vertical lines) of erosion score (A), joint space narrowing (JSN) (B) and total Sharp van der Heijde score (SHS) (C) between inclusion and the 1, 2 and 5 year examinations. Group UnCh, patients with unchanged serum-COMP levels from inclusion to 3 months follow-up (change ≤ 20%), Group DeCr, patients with decreasing serum-COMP levels from inclusion to 3 months follow-up (decrease > 20%) and Group InCr, patients with increasing serum-COMP levels from inclusion to 3 months follow-up (increase > 20%). P-values denote results of Kruskal-Wallis test between groups at 1, 2 and 5 years.
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Figure 2: Median change of erosion score (A), joint space narrowing (JSN) (B) and total Sharp van der Heijde score (SHS) (C) between inclusion and the 1, 2 and 5 year examinations. Figure 2 shows median change with 75% CI (denoted by vertical lines) of erosion score (A), joint space narrowing (JSN) (B) and total Sharp van der Heijde score (SHS) (C) between inclusion and the 1, 2 and 5 year examinations. Group UnCh, patients with unchanged serum-COMP levels from inclusion to 3 months follow-up (change ≤ 20%), Group DeCr, patients with decreasing serum-COMP levels from inclusion to 3 months follow-up (decrease > 20%) and Group InCr, patients with increasing serum-COMP levels from inclusion to 3 months follow-up (increase > 20%). P-values denote results of Kruskal-Wallis test between groups at 1, 2 and 5 years.

Mentions: Radiographic progression after 5 years (change in total SHS score with 5.8 or more) was significantly more frequent in the InCr group, 71%, than in the other groups, 46% and 46% respectively, overall p=0.022. In the InCr group the median change in erosion score was significantly higher compared with that in the other groups at 1, 2 and 5 years, Figure 2A. Pair wise comparisons of changes in erosion score indicated significant differences between groups. Thus, group InCr showed a greater increase in erosion score than the other groups at all time points, Figure 2A. Similarly, the median change in total SHS was larger in this group but not statistically significant at all time points, Figure 2C. There were no significant differences between the groups regarding change in JSN score Figure 2B.


Early increase in serum-COMP is associated with joint damage progression over the first five years in patients with rheumatoid arthritis.

Andersson ML, Svensson B, Petersson IF, Hafström I, Albertsson K, Forslind K, Heinegård D, Saxne T - BMC Musculoskelet Disord (2013)

Median change of erosion score (A), joint space narrowing (JSN) (B) and total Sharp van der Heijde score (SHS) (C) between inclusion and the 1, 2 and 5 year examinations. Figure 2 shows median change with 75% CI (denoted by vertical lines) of erosion score (A), joint space narrowing (JSN) (B) and total Sharp van der Heijde score (SHS) (C) between inclusion and the 1, 2 and 5 year examinations. Group UnCh, patients with unchanged serum-COMP levels from inclusion to 3 months follow-up (change ≤ 20%), Group DeCr, patients with decreasing serum-COMP levels from inclusion to 3 months follow-up (decrease > 20%) and Group InCr, patients with increasing serum-COMP levels from inclusion to 3 months follow-up (increase > 20%). P-values denote results of Kruskal-Wallis test between groups at 1, 2 and 5 years.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750296&req=5

Figure 2: Median change of erosion score (A), joint space narrowing (JSN) (B) and total Sharp van der Heijde score (SHS) (C) between inclusion and the 1, 2 and 5 year examinations. Figure 2 shows median change with 75% CI (denoted by vertical lines) of erosion score (A), joint space narrowing (JSN) (B) and total Sharp van der Heijde score (SHS) (C) between inclusion and the 1, 2 and 5 year examinations. Group UnCh, patients with unchanged serum-COMP levels from inclusion to 3 months follow-up (change ≤ 20%), Group DeCr, patients with decreasing serum-COMP levels from inclusion to 3 months follow-up (decrease > 20%) and Group InCr, patients with increasing serum-COMP levels from inclusion to 3 months follow-up (increase > 20%). P-values denote results of Kruskal-Wallis test between groups at 1, 2 and 5 years.
Mentions: Radiographic progression after 5 years (change in total SHS score with 5.8 or more) was significantly more frequent in the InCr group, 71%, than in the other groups, 46% and 46% respectively, overall p=0.022. In the InCr group the median change in erosion score was significantly higher compared with that in the other groups at 1, 2 and 5 years, Figure 2A. Pair wise comparisons of changes in erosion score indicated significant differences between groups. Thus, group InCr showed a greater increase in erosion score than the other groups at all time points, Figure 2A. Similarly, the median change in total SHS was larger in this group but not statistically significant at all time points, Figure 2C. There were no significant differences between the groups regarding change in JSN score Figure 2B.

Bottom Line: Radiographic progression was defined as increase in SHS by ≥5.8.The group of patients with increasing COMP levels showed higher median change in total SHS and erosion scores at 1, 2 and 5 year follow-up compared with the groups with stable or decreasing COMP levels.Importantly, neither did changes over the 3-month period in DAS28, HAQ, ESR nor CRP differ between the groups and these variables did not correlate to joint damage progression.

View Article: PubMed Central - HTML - PubMed

Affiliation: R and D center, Spenshult Hospital, Oskarström, Sweden. maria.andersson@spenshult.se

ABSTRACT

Background: Currently available biomarkers for the early tissue process leading to joint damage in rheumatoid arthritis are insufficient and lack prognostic accuracy, possibly a result of variable activity of the disease over time. This study represents a novel approach to detect an altered activity of the disease process detected as increasing serum-COMP levels over a short time and whether this would correlate with joint damage progression over the first 5 years of disease.

Methods: In all, 349 patients from the Swedish BARFOT early RA study were examined. Serum-COMP was analysed by ELISA at diagnosis and after 3 months. Based on changes in serum-COMP levels, three subgroups of patients were defined: those with unchanged levels (change ≤ 20%) (N=142), decreasing levels (> 20%) (N=173) and increasing levels (> 20%) (N=34). Radiographs of hands and feet were obtained at inclusion, after 1, 2 and 5 years and scored according to Sharp van der Heijde (SHS). Radiographic progression was defined as increase in SHS by ≥5.8.

Results: The group of patients with increasing COMP levels showed higher median change in total SHS and erosion scores at 1, 2 and 5 year follow-up compared with the groups with stable or decreasing COMP levels. Furthermore, the odds ratio of radiographic progression was 2.8 (95% CI 1.26-6.38) for patients with increasing COMP levels vs. patients with unchanged levels.The group of patients with increasing COMP levels had higher ESR at inclusion but there were no baseline differences between the groups for age, gender, disease duration, disease activity (DAS28), function (HAQ), CRP, nor presence of rheumatoid factor or anti-CCP. Importantly, neither did changes over the 3-month period in DAS28, HAQ, ESR nor CRP differ between the groups and these variables did not correlate to joint damage progression.

Conclusion: Increasing serum-COMP levels between diagnosis and the subsequent 3 months in patients with early RA represents a novel indicator of an activated destructive process in the joint and is a promising tool to identify patients with significant joint damage progression during a 5-year period.

Show MeSH
Related in: MedlinePlus