Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Flt3-L Is a Novel Biomarker Increased in Cerebrospinal Fluid of Patients with Primary Fibromyalgia and Sjogren Syndrome.

L. Bjersing,  Jan, Dehlin,  Mats, Zetterberg,  Henrik, Larsson,  Anette, Erlandsson,  Malin, Mannerkorpi,  Kaisa, Bokarewa,  Maria

Primary fibromyalgia syndrome (FM) is a non-inflammatory condition, characterised by chronic generalized pain with allodynia. Primary Sjogren syndrome (pSS) is an autoimmune inflammation of exocrine glands. Fms-like tyrosine kinase 3 (Flt3-L) is a growth factor expressed in brain microglia and regulating differentiation and recruitment of monocytes into dendritic and glial cells. Both FM and pSS are commonly associated with fatigue and non-restorative sleep, and occasionally with depression and cognitive dysfunction. The aim of the study was to compare inflammatory and axonal biomarkers in cerebrospinal fluid (CSF) of pSS and FM patients.

Paired samples of CSF and serum from female patients with pSS (age 48±12 years, disease duration 10±8 years) and FM (age 49±8 years, symptom duration 12±5 years) were evaluated for the levels of Flt3-L and related to inflammatory (IL-6, IL-8) and axonal (NFL, Tau, phosphorylated Tau, GFAP) biomarkers.

Flt3-L in CSF was significantly higher in FM patients compared to pSS patients (table 1). The proportion of phosphorylated Tau (pTau) to total Tau (tTau) was significantly higher in FM compared to SS. However, total levels of tTau and pTau were not different between the groups. Flt3-L in CSF correlated with levels of tTau and pTau, in both pSS (r=0.68, r=0.65) and FM (r=0.38, r=0.45). In FM, Flt3-L was also associated with neurofilament light chain (NFL, r=0.41) and astrocyte marker glial fibrillary acidic protein (GFAP, r=0.58). Flt3-L in CSF correlated with Flt3-L in serum of patients with pSS (r=0.53) but not in FM. IL-6 in CSF was significantly higher in pSS patients compared to FM (table 1). No correlation was found between Flt3-L and IL-6. Serum levels of IL-6, IL-8 or Flt3-L were not significantly different between pSS and FM patients.

Table 1. Levels of biomarkers in cerebrospinal fluid in primary fibromyalgia (FM) and primary Sjögren syndrome (pSS)

 Flt3-L pg/mlIL6 pg/mlIL8 pg/mltTau/pTauNFL ng/LGFAP ng/L
n = 15[28; 76][0.7; 4.5][54; 25][3.8; 5.3][240; 1780][170; 860]
n = 34[46; 95][0; 3.3][20; 51][0; 5.2][250; 1550][230; 2320]
Values are presented as median [min, max]. Mann-Whitney U-test was used.

Flt3-L is a novel biomarker in CSF, distinguishing patients with FM and pSS. Levels of Flt3-L are positively related with axonal products, suggesting potential clinical impact of Flt3-L in fatigue and pain of patients with FM and pSS.

To cite this abstract, please use the following information:
L. Bjersing, Jan, Dehlin, Mats, Zetterberg, Henrik, Larsson, Anette, Erlandsson, Malin, Mannerkorpi, Kaisa, et al; Flt3-L Is a Novel Biomarker Increased in Cerebrospinal Fluid of Patients with Primary Fibromyalgia and Sjogren Syndrome. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :103
DOI: 10.1002/art.27872

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