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.


Long Term Profile of Cytokine, Metalloproteinase and Cartilage Biomarkers in Psoriatic Arthritis Patients Treated with Biologic Therapy.

Luis Fernandez-Sueiro,  Jose, Fernandez-Lopez,  J. C., Oreiro-Villar,  N., Pertega-Diaz,  S., Pinto,  J. A., Blanco,  FJ

Objective:

to assess the cytokine, metalloproteinase (MMP) and cartilage biomarkers (CB) profile in long term psoriatic arthritis (PsA) patients treated with biologic therapy.

Patients and Methods:

PsA patients met CASPAR criteria. Biologic therapy was started following the recommendations of the Spanish Society of Rheumatology. Patients were evaluated just before starting therapy and then every 12 weeks until last evaluation. In each visit SJC, TJC, VAS patient, physician, total pain, morning stiffness, HAQ, ESR and CRP was performed. Serum and blood was taken just before starting therapy and then every 12 weeks. For this study we analysed serum samples before starting therapy and at the last evaluation. We determined by ELISA the following: IL-1b, IL-6, IL-10, TNFa, MMP-1, MMP-3, C2C and CPII. All determinations were performed with commercial kits following the manufacturer's instructions. For the statistical analysis, Mann-Whitney test and Wilcoxon signed-rank tests were used.

Results:

38 PsA patients started the study, 19 were females. The mean age was 43.1±10.6 years; mean time of evolution was 8.2±4.8 years, mean time of follow up 47.6±15.2 months. 16 patients (42.1%) were treated with infliximab (INFx) and 22 (57.9%) were treated with etanercept (ETA) at start, in the last visit 9 patients were on INFX, 21 with ETA and 4 with adalimumab. 28 patients (73.7%) had peripheral disease and 10 patients (26,3%) had "mixed" disease. Basal clinical features were as follows: TJC 11.7±7.4, SJC 5.6±4.1, morning stiffness 39.9±24.2 minutes, VAS pain 63.5±18.0mm, VAS patient 64.8±17.6mm, VAS physician 52.0±10.7mm, HAQ 1.4±0.7, ESR 29.0±23.9 mm1/h, CRP 3.0±6.7 mg/dl.

With respect to the first visit, at last visit there was a significant monthly decrease in IL-6, MMP3 (ng/ml) and C2C and an increase in CPII/C2C.

22 (64.7%) patients reached an ACR20, in these patients there was a significant decrease in IL-6, MMP-3 and C2C and an increase in CPII/C2C values with regard to basal levels.

In non responders (n=12), there were differences but not at the same level of significance. According to the pattern of joint involvement, there were basal differences in the levels of MMP-3 (peripheral 6.10±3.68 vs "mixed" 3.34±2.04, p=0.031).

Conclusion:

In the long term follow up of PsA patients treated with biologic therapy, IL-6, MMP-3 and C2C decrease whereas CPII/C2C increases, however these changes are more profound if patients clinically respond to therapy as assessed by ACR20. In this long term follow up study, IL-6, MMP-3 as well as CPII/C2C seems good markers of synovial inflammation and cartilage metabolism.

Table I. Average monthly change of Cytokine, metalloproteinase and cartilage biomarkers from basal to last visit.

 Last visit-Basal visit
 MeanSDp*
IL-1b*0.00040.02630.923
IL-6*-0.16390.2292<0.001
IL-10*0.0230.0750.111
TNFa*-0.4332.8140.423
MMP-1†-0.0180.0610.091
MMP-3†-0.4500.655<0.001
C2C†-0.2300.256<0.001
CPII†0.3182.5830.478
CPII/C2C0.0860.1340.001
ESR‡-0.050.410.456
CRP#-0.050.200.161
*pg/ml,†ng/ml,‡mml ahour,#mg/dl

Table II. Average monthly change of Cytokine, metalloproteinase and cartilage biomarkers from basal to last visit according to ACR20 response.

 ACR20 responders (n = 22)ACR20 non responders (n = 12)
 Last visit-Basal visitLast visit-Basal visit
 MeanSDpMeanSDp
IL-1b*0.0030.0290.583-0.0050.0200.408
IL-6*-0.2120.2550.001-0.0680.1280.107
IL-10*0.0280.0920.1650.0140.0220.043
TNFa*-0.8373.2550.2640.5770.4090.005
MMP-1†-0.0250.0640.083-0.0060.0560.715
MMP-3†-0.5660.605<0.001-0.2390.7170.273
C2C†-0.2320.246<0.001-0.2270.2850.019
CPII†-0.0541.7210.8840.9993.6850.368
CPII/C2C0.0740.1290.0140.1090.1450.025
ESR‡-0.0750.4810.473-0.0140.2640.856
CRP#-0.0750.2480.173-0.0030.0130.405
*pg/ml,†ng/ml,‡mm1 ahour,#mg/dl   

To cite this abstract, please use the following information:
Luis Fernandez-Sueiro, Jose, Fernandez-Lopez, J. C., Oreiro-Villar, N., Pertega-Diaz, S., Pinto, J. A., Blanco, FJ; Long Term Profile of Cytokine, Metalloproteinase and Cartilage Biomarkers in Psoriatic Arthritis Patients Treated with Biologic Therapy. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :541
DOI: 10.1002/art.28310

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