Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Baseline Serum Levels of CXCL13 Are Associated with Ultrasonographic Synovitis and Predict Power Doppler Persistency in Early Rheumatoid Arthritis.
Manzo, Antonio, Bugatti, Serena, Benaglio, Francesca, Vitolo, Barbara, Todoerti, Monica, Sakellariou, Garifallia, Caporali, Roberto
The course of rheumatoid arthritis (RA) is highly variable among different patients. To optimise management, individual's outcomes need to be recognised as early as possible. Novel biological markers specifically reflecting the severity of synovial inflammation at presentation could be more predictive than routine clinical and laboratory assessments. Here we aimed at investigating the associations of baseline serum levels of CXCL13 (sCXCL13), a chemokine critically involved in B and T cell recruitment and cooperation within lymphoid and extra-lymphoid sites, with changes in clinical and ultrasonographic (US) disease activity in patients with recent-onset RA over a 12 months follow-up.
Study subjects were 161 early RA patients (disease duration < 1 year) treated according to a disease activity score (DAS)-driven step-up protocol aimed at low disease activity (LDA, DAS28<3.2). US examination of hands was performed at baseline and 12 months. Power Doppler (PD) synovitis was scored (03), with overall scores as the sum of each joint score. sCXCL13 was assessed by ELISA at baseline and, in 87 patients, after 2 months of therapy. sCXCL13 levels were analysed in relation to the following outcomes at 12 months: clinical LDA and remission according to conventional DAS28 and SDAI cut-off values, total PD score and US remission (total PD score = 0).
At baseline, sCXCL13 levels were associated with objective and semi-objective measures of disease activity, such as the swollen joint count (rho 0.22, p=0.009), the evaluator global assessment of disease activity (rho 0.26, p=0.002), the erythrocyte sedimentation rate (ESR) (rho 0.41, p<0.0001) and C-reactive protein (CRP) levels (rho 0.41, p<0.0001). Confirming the specific relationship with measures of synovitis, sCXCL13 significantly correlated with baseline PD scores (rho 0.26, p=0.006). When compared to CRP, only sCXCL13 retained independent predictive value for the PD score. Furthermore, differently from CRP, sCXCL13 levels were significantly higher in ACPA-positive patients [96.82 (95%CI 72.61117.19) vs 68.53 (95%CI 54.3775.03), p=0.001]. sCXCL13 levels appeared mostly unchanged after 2 months of therapy (mean difference 4.62, 95% CI -3.37 11.4, p=0.27), as opposite to the other clinical and laboratory parameters which all significantly decreased. Baseline sCXCL13 did not predict clinical outcomes at 12 months. Rather, sCXCL13 levels were the only independent predictor of the 12 months PD score (p=0.02) and PD remission (p=0.04), irrespective of initial PD scores, disease activity status, acute phase reactants and autoantibodies. Using the Receiver Operating Characteristic curve, the relative risk of US remission was averaged 60% higher in patients with baseline sCXCL13 <106.75 pg/ml (OR 3.56, 95%CI 1.448.79).
CXCL13 emerges as a new biological marker in early RA, accurate in assessing the severity of sinovitis and its persistency over time in response to conventional treatments.
To cite this abstract, please use the following information:
Manzo, Antonio, Bugatti, Serena, Benaglio, Francesca, Vitolo, Barbara, Todoerti, Monica, Sakellariou, Garifallia, et al; Baseline Serum Levels of CXCL13 Are Associated with Ultrasonographic Synovitis and Predict Power Doppler Persistency in Early Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :350