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.
Assessment of Nontraditional Prognostic Markers in Patients with Rheumatoid Arthritis.
Majdan, Bozena Targonska-Stepniak and Maria
Rheumatoid arthritis (RA) is associated with patients' shortened life expectancy. Premature deaths are mostly due to accelerated cardiovascular disease (CVD) which cannot only be explained by the presence of traditional CV risk factors. The search for early markers of poor prognosis seems to be crucial. N-terminal pro-BNP (NT-proBNP) concentrations are increased in CVD and predict the risk of CV events. Renal involvement worsens both the course of RA and CVD. Cystatin C (Cys-C) is used as an endogenous, precise marker for glomerular filtration rate. Carotid intima-media thickness (cIMT) assessed by ultrasound reflects early stages of atherosclerosis and is a strong predictor of CV events.
The purpose of the study was to assess the value of chosen prognostic markers in patients with RA in association with markers of disease activity.
The study population consisted of 140 RA patients (111 women and 29 men); with the mean (SD): age 50.3 (10.9) years and disease duration 120.6 (89.8) months. Disease Activity Score in 28 joints (DAS28) was calculated as a primary outcome measure. High disease activity (DAS28>=5.1) was observed in 42 patients (30%), erosive form of RA in 117 (83.6%). Plasma NT-proBNP concentration was assessed in patients and 20 healthy controls with chemiluminescent immunometric method. Serum Cys-C concentration was assessed with quantitative enhanced immunonephelometry method (normal range 0.53 0.95 mg/l). cIMT was measured in patients and 31 healthy controls using high-resolution B-mode ultrasonography.
The mean (SD) concentration of NT-proBNP was significantly higher in RA patients than in controls [120.1 (212.3) pg/ml vs 30.8 (30.6) pg/ml (p< 0.0001)], as well as cIMT [0.75 (0.17) mm vs 0.59 (0.12) mm] (p< 0.0001)]. The mean (SD) serum Cys-C concentration was 0.78 (0.3) mg/l (range 0.423.37).
The three markers correlated positively with each other (NT-proBNP and cIMT: R=0.29; p=0.0005; NT-proBNP and Cys-C: R=0.34; p=0.00003; Cys-C and cIMT: R=0.44; p=0.00001). There were significant associations with metabolic variables: between cIMT and cholesterol (total and LDL), atherogenic index, glucose, body mass index; between Cys-C concentration and triglycerides, atherogenic index.
The value of cIMT, Cys-C, NT-proBNP correlated positively with the patients' age and inflammatory markers (ESR, fibrinogen). Both NT-proBNP and Cys-C were also significantly associated with markers of RA: immunological (ACPA) and functional (HAQ). Only Cys-C concentration showed significant correlation with markers of disease activity (DAS28, CRP, morning stiffness, VAS patient's global assessment of disease activity).
The values of Cys-C, NT-proBNP and cIMT in RA patients were associated with the age and metabolic parameters, but also with markers of the disease activity. These nontraditional prognostic markers may be helpful in early diagnosis of complications associated with the course of RA.
To cite this abstract, please use the following information:
Majdan, Bozena Targonska-Stepniak and Maria; Assessment of Nontraditional Prognostic Markers in Patients with Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1742