Calprotectin as a marker of inflammation in patients with early rheumatoid arthritis

• Published in: Annals of the Rheumatic Diseases
• Main Authors: Jonsson, Maria Karolina, Sundlisæter, Nina Paulshus, Nordal, Hilde Haugedal, Hammer, Hilde Berner, Aga, Anna-Birgitte, Olsen, Inge Christoffer, Brokstad, Karl Albert, van der Heijde, Désirée, Kvien, Tore K, Fevang, Bjørg-Tilde Svanes, Lillegraven, Siri, Haavardsholm, Espen A
• Other Authors: The Norwegian Rheumatism Association, MSD, The Norwegian Research Council, The Norwegian Women’s Public Health Association, Pfizer, The Western Norway Regional Health Authority, The Borgny Kleppe Legacy, UCB, The Southern and Eastern Norway Regional Health Authority, The Norwegian ExtraFoundation for Health and Rehabilitation, Roche, AbbVie
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMJ 2017
• Subjects: Arctic
• Online Access: http://dx.doi.org/10.1136/annrheumdis-2017-211695; https://syndication.highwire.org/content/doi/10.1136/annrheumdis-2017-211695

Objectives Calprotectin is an inflammatory marker of interest in rheumatoid arthritis (RA). We evaluated whether the level of calprotectin was associated with disease activity, and if it was predictive of treatment response and radiographic progression in patients with early RA. Methods Plasma from disease-modifying antirheumatic drug (DMARD)-naïve patients with RA fulfilling 2010 American College of Rheumatology/European League Against Rheumatism classification criteria with symptom duration <2 years was analysed for calprotectin at baseline, and after 1, 3 and 12 months. All patients received treat-to-target therapy, as part of a randomised controlled strategy trial (ARCTIC). The association between calprotectin, erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) and measures of disease activity were assessed by correlations. We used likelihood ratios and logistic regression models to assess the predictive value of the baseline inflammatory markers for treatment response and radiographic damage. Results 215 patients were included: 61% female, 82% anti-citrullinated peptide antibody positive, mean (SD) age 50.9 (13.7) years and median (25, 75 percentile) symptom duration 5.8 (2.8, 10.5) months. Calprotectin was significantly correlated with Clinical Disease Activity Index (r=0.32), ESR (r=0.50) and ultrasonography power Doppler (r=0.42) before treatment onset. After 12 months of treatment, calprotectin, but not ESR and CRP, was significantly correlated with power Doppler (r=0.27). Baseline levels of calprotectin, ESR and CRP were not predictive of treatment response, but high levels of calprotectin were associated with radiographic progression in multivariate models. Conclusions Calprotectin was correlated with inflammation assessed by ultrasound before and during DMARD treatment, and was also associated with radiographic progression. The data support that calprotectin may be of interest as an inflammatory marker when assessing disease activity in different stages of RA. Trial registration ...