Calprotectin in Rheumatoid Arthritis
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Calprotectin is potentially a more sensitive biomarker of disease activity in rheumatoid arthritis (RA) than conventional acute-phase proteins such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) because it directly reflects inflammation in the synovium and synovial fluid rather than systemic inflammatory activity.
The aim of this study was to evaluate relationships between serum calprotectin levels, disease activity, and response to treatment. Calprotectin was also investigated as a predictive marker of clinical response.
This observational study included selected cohorts of patients with RA treated at La Paz University Hospital, Madrid, Spain. Associations between serum calprotectin levels and clinical and laboratory parameters were analyzed in a cross-sectional cohort of 60 patients with varying disease activity, and changes in calprotectin levels in response to treatment with infliximab were analyzed at baseline and after 3 and 6 months of treatment in a longitudinal cohort of 20 patients with very active disease.
In the cross-sectional cohort, calprotectin levels correlated with rheumatoid factor levels (r = 0.25; p < 0.05) but not with titers of antibodies to cyclic citrullinated peptide. Significant correlations were also observed between calprotectin levels and the 28 swollen joint count (28-SJC), Disease Activity Score based on a 28-joint count (DAS28), Simplified Disease Activity Index (SDAI), ESR, and CRP levels. In the longitudinal cohort, calprotectin levels at baseline were not predictive of response to treatment but significantly decreased during treatment in responders (p < 0.0001).
Calprotectin levels strongly correlate with clinical and laboratory assessments of joint inflammation and also decrease in response to treatment, indicating that calprotectin is a promising marker for assessment and monitoring of disease activity in patients with RA. Investigations are required to further evaluate its diagnostic, prognostic, and therapeutic potential.
KeywordsInfliximab Rheumatoid Arthritis Patient High Disease Activity Simplify Disease Activity Index Calprotectin Level
This work was supported by an unrestricted grant from UCB Pharma (Madrid, Spain). Technical editing and manuscript styling assistance was provided by Andrea Bothwell of inScience Communications, Springer Healthcare, with funding provided by UCB Pharma. Marie-Eve Ueberschlag and Thomas M. Jermann are employees of Bühlmann Laboratories AG (Schönenbuch, Switzerland). Carlos Cara is an employee of UCB Pharma. Alejandro Balsa has received grants and consulting fees/honoraria from UCB Pharma. The authors have no other conflicts of interest that are directly relevant to the content of this article.
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