Plasma calprotectin may be biomarker of active synovitis in patients with RA
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Calprotectin was found to be related to ultrasound synovitis scores in patients with rheumatoid arthritis treated with interleukin-6 inhibitors and janus kinase inhibitors, according to a poster presented at ACR Convergence 2021.
While IL-6 inhibitors can have a “dramatic effect” on C-reactive protein in patients with RA, the CRP serum levels “do not correlate with inflammatory activity” and IL-6 signaling is partly hampered by JAK inhibitors.
“Calprotectin is a protein that correlates closely with inflammatory activity and may be a biomarker that accurately reflects the disease status in IL-6 inhibitor and JAK inhibitor treated RA patients,” Beatriz Frade-Sosa, MD, of the Hospital Clinic of Barcelona, and colleagues wrote.
In a cross-sectional study, Frade-Sosa and colleagues included 78 patients with RA, 52 of whom were treated with IL-6 inhibitors and 26 with JAK inhibitors. The researchers compared plasma calprotectin with clinical and ultrasound variables between the cohorts, performing ultrasound studies in 42 subjects receiving IL-6 inhibitors and 21 receiving JAK inhibitors.
The study evaluated demographic data, serological data (autoantibodies, erythrocyte sedimentation rate, ultrasensitive CRP [usCRP]), composite activity indices (disease activity score or DAS28, simple disease activity index or SDAI, clinical disease activity index or CDAI, routine assessment of patient index data 3 or RAPID3), disability and therapy. Hand ultrasound was evaluated to determine synovial hypertrophy, power Doppler signal score and total ultrasound activity score.
The median plasma calprotectin level was 0.65 g/mL in patients treated with JAK inhibitors and 0.36 g/mL in patients treated with IL-6 inhibitors. The study found no significant between-group differences in ultrasound scores or in tender joint count, swollen joint count, disability, CDAI, or SDAI. However, DAS28 was higher in patients treated with JAK inhibitors than in patients treated with IL-6 inhibitors (3.78 and 2.26, respectively), according to the poster abstract.
In patients treated with JAK inhibitors, there was a high correlation found between plasma calprotectin and usCRP levels (rho = 0.552), and in both groups, calprotectin significantly correlated with all ultrasound scores.
Classification according to ultrasound activity in one or more joint showed higher calprotectin levels in patients with ultrasound synovitis than in those without (median 0.70 g/mL vs. 0.29 g/mL), according to the poster.
Whereas calprotectin was related to ultrasound synovitis scores in both groups and especially in patients treated with JAK inhibitors, “plasma calprotectin in patients with low-moderate disease activity treated with IL-6 inhibitors or JAK inhibitors did not identify patients according to the degree of inflammation measured by the composite activity indices,” the researchers wrote.
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Frade-Sosa B, et al. Abstract #1209. Presented at: ACR Convergence 2021; November 3-10, 2021 (virtual meeting).
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