Ankilozan Spondilitli Hastalarda Akut Faz Reaktanlarının Değerlendirilmesi

Abstract

Amaç: Ankilozan spondilit (AS) hastalarının tanı ve takipteki yüksek akut faz reaktanları (AFR) düzeylerini belirlemek ve hastaların yüksek AFR düzeyleri ile hastalık aktivite düzeyleri ve klinik özellikleri arasındaki ilişkiyi araştırmak. Gereç ve Yöntem: Modifiye 1984 New York kriterlerine göre AS tanısı alan ve üniversite romatoloji kliniğinde takip edilen 948 hasta bu çalışmaya dahil edildi. Tüm ziyaretlerdeki hastaların eritrosit sedimantasyon hızı (ESH) ve C-reaktif protein (CRP) seviyeleri kayıt defteri ve hastanenin veri tabanı aracılığıyla geriye dönük olarak incelendi. Bulgular: İlk ziyarette, sırasıyla 626 (%68,5) ve 578 (%64,6) hastada yüksek CRP ve ESH seviyeleri gözlendi. Takip sırasında hastaların %84,6'sında yüksek CRP ve %69,5'inde yüksek ESH vardı, ancak hastaların %10'unda AFR hiç yükselmedi. ESH ile CRP arasında iyi bir korelasyon vardı (r=0,666 , p=0,000). İlk ziyarette CRP ile BASDAI (r=0,81, p=0,23) veya ASDAS (r=0,468 , p=0,000) arasında ESH ve BASDAI (r=0,111 , p=0,02) veya ASDAS ile karşılaştırıldığında daha iyi bir korelasyon gözlendi r=0,334, p=0,000). BASDAI ile karşılaştırıldığında, ESH (p=0,00) veya CRP (çok yüksek hastalık aktivitesi-p=0,000, inaktif hastalık-p=0,001) olan ASDAS, hastanın aktivitesini inaktif ve çok yüksek düzeyde şiddetli hastalık olarak değerlendirmede daha iyi performans gösterdi. Sonuç: Sonuçlarımız, AS hastalarında yüksek düzeyde akut faz reaktanlarının nadir olmadığını gösterdi. AFR, AS'nin değerlendirilmesinde ve/veya tedaviye yanıtta en önemli laboratuvar diagnostiği olarak düşünülmelidir.

Keywords

• Ankilozan spondilit
• akut faz reaktanı
• eritrosit sedimantasyon hızı
• C-reaktif protein
• hastalık aktivite indeksi

Evaluation of Acute Phase Reactants in Patients with Ankylosing Spondylitis

Abstract

Objective: To determine the high levels of acute phase reactants (APR) of ankylosing spondylitis (AS) patients at diagnosis and follow-up, and to investigate the relationship between patients’ high levels of APR and patients’ disease activity levels and clinical characteristics. Material and Methods : 948 patients who were diagnosed with AS according to the modified 1984 New York criteria and followed-up at the university rheumatology clinic were included in this study. The patients’ erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels across all visits were retrospectively reviewed through the registry and the hospital’s database. Results: At first visit, high levels of CRP and ESR were observed in 626 (68.5%) and 578 (64.6%) patients respectively. During follow-up 84.6% of patients had high CRP and 69.5% patients had high ESR, however in 10% of patients APRs did not increase at all. There was good correlation between ESR and CRP (r=0.666, p=0.000). A better correlation was observed at first visit between CRP and BASDAI (r=0.81, p=0.23) or ASDAS (r=0.468, p=0.000) compared to ESR and BASDAI (r=0.111, p=0.02) or ASDAS (r=0.334, p=0.000). Compared to BASDAI, ASDAS with either ESR (p=0.00) or CRP (very high disease activity-p=0.000, inactive disease-p=0.001) had better performance in evaluating the activity of the patient in inactive and very high levels of severe disease. Conclusions: Our results showed, high levels of acute phase reactants is not rare in AS patients. APR should be considered the most significant laboratory diagnostics in the evaluation of AS and/or response to the treatment.

Keywords

• Ankylosing spondylitis
• acute phase reactant
• erythrocyte sedimentation rate
• C-reactive protein
• disease activity index

References

1. Sieper J, Braun J, Rudwaleit M, et al. Ankylosing spondylitis: an overview. Ann Rheum Dis. 2002 Dec;61 Suppl 3(Suppl 3):iii8-18.
2. Spoorenberg A, van der Heijde D, de Klerk E, et al. Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol. 1999 Apr;26(4):980–4.
3. Ruof J, Stucki G. Validity aspects of erythrocyte sedimentation rate and C-reactive protein in ankylosing spondylitis: a literature review. J Rheumatol. 1999 Apr;26(4):966–70.
4. Dougados M, Gueguen A, Nakache JP, et al. Clinical relevance of C-reactive protein in axial involvement of ankylosing spondylitis. J Rheumatol. 1999 Apr;26(4):971–4.
5. Claushuis TAM, de Vries MK, van der Weijden MAC, et al. C-reactive protein polymorphisms influence serum CRP-levels independent of disease activity in ankylosing spondylitis. Clin Exp Rheumatol. 2015;33(2):159–65.
6. de Vries MK, van Eijk IC, van der Horst-Bruinsma IE, et al. Erythrocyte sedimentation rate, C-reactive protein level, and serum amyloid a protein for patient selection and monitoring of anti-tumor necrosis factor treatment in ankylosing spondylitis. Arthritis Rheum. 2009 Nov;61(11):1484–90.
7. Elyan M, Khan MA. Diagnosing ankylosing spondylitis. J Rheumatol Suppl. 2006 Sep;78:12–23.
8. McVeigh CM, Cairns AP. Diagnosis and management of ankylosing spondylitis. BMJ. 2006 Sep;333(7568):581–5.

9. Lin T-T, Lu J, Qi C-Y, et al. Elevated serum level of IL-27 and VEGF in patients with ankylosing spondylitis and associate with disease activity. Clin Exp Med. 2015 May;15(2):227–31.
10. Bodur H, Ataman S, Akbulut L, et al. Characteristics and medical management of patients with rheumatoid arthritis and ankylosing spondylitis. Clin Rheumatol. 2008 Sep;27(9):1119–25.
11. Çağlar NS, Burnaz Ö, Akın T, et al. Demographic and Clinical Properties and Medical Treatments of Patients Followed as Ankylosing Spondylitis. Istanbul Med J. 2011;12(1):19–24.
12. Baskan BM, Sivas F, Inal EE, et al. Comparison of the Bath Ankylosing Spondylitis Radiology Index and the modified Stoke Ankylosing Spondylitis Spine Score in Turkish patients with ankylosing spondylitis. Clin Rheumatol. 2010 Jan;29(1):65–70.
13. Macfarlane GJ, Barnish MS, Jones EA, et al. The British Society for Rheumatology Biologics Registers in Ankylosing Spondylitis (BSRBR-AS) study: Protocol for a prospective cohort study of the long-term safety and quality of life outcomes of biologic treatment. BMC Musculoskelet Disord. 2015 Nov;16:347.
14. Sheehan NJ, Slavin BM, Donovan MP, et al. Lack of correlation between clinical disease activity and erythrocyte sedimentation rate, acute phase proteins or protease inhibitors in ankylosing spondylitis. Br J Rheumatol. 1986 May;25(2):171–4.
15. Cansu DU, Calisir C, Savas Yavas U, et al. Predictors of radiographic severity and functional disability in Turkish patients with ankylosing spondylitis. Clin Rheumatol. 2011 Apr;30(4):557–62.
16. Doran MF, Brophy S, MacKay K, et al. Predictors of longterm outcome in ankylosing spondylitis. J Rheumatol. 2003 Feb;30(2):316–20.
17. Linssen A. B27 Disease versus B27 Disease. Scand J Rheumatol. 1990;19(sup87):111–9.
18. Khan MA, Kushner I, Braun WE, et al. HLA--B27 homozygosity in ankylosing spondylitis: relationship to risk and severity. Tissue Antigens. 1978 May;11(5):434–8.
19. Saraux A, de Saint-Pierre V, Baron D, et al. The HLA B27 antigen-spondylarthropathy association. Impact on clinical expression. Rev Rhum Engl Ed. 1995;62(7–8):487–91.
20. Chung HY, Machado P, van der Heijde D, et al. HLA-B27 positive patients differ from HLA-B27 negative patients in clinical presentation and imaging: results from the DESIR cohort of patients with recent onset axial spondyloarthritis. Ann Rheum Dis. 2011 Nov;70(11):1930–6.