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Elevated faecal calprotectin is linked to worse disease status in axial spondyloarthritis : Results from the SPARTAKUS cohort

Olofsson, Tor LU ; Lindqvist, Elisabet LU ; Mogard, Elisabeth LU ; Andréasson, Kristofer LU ; Marsal, Jan LU ; Geijer, Mats LU ; Kristensen, Lars Erik LU and Wallman, Johan K. LU (2019) In Rheumatology (United Kingdom) 58(7). p.1176-1187
Abstract

Objectives. To examine faecal calprotectin (F-calprotectin) levels and presence of anti-Saccharomyces cerevisiae antibodies (ASCA) and their associations with disease subtype and current status in axial SpA (axSpA). Methods. F-calprotectin and ASCA in serum were compared between consecutive patients with a clinical axSpA diagnosis, classified as non-radiographic axSpA (nr-axSpA; n = 40) or AS (n = 90), and with healthy controls (n = 35). Furthermore, standard axSpA outcome measures were compared between axSpA patients (nr-axSpA and AS combined) with elevated vs normal F-calprotectin, ASCA IgA and IgG, respectively. Results. Elevated F-calprotectin (≥50 mg/kg) was observed in 27% of nr-axSpA patients, 38% of AS patients and 6% of... (More)

Objectives. To examine faecal calprotectin (F-calprotectin) levels and presence of anti-Saccharomyces cerevisiae antibodies (ASCA) and their associations with disease subtype and current status in axial SpA (axSpA). Methods. F-calprotectin and ASCA in serum were compared between consecutive patients with a clinical axSpA diagnosis, classified as non-radiographic axSpA (nr-axSpA; n = 40) or AS (n = 90), and with healthy controls (n = 35). Furthermore, standard axSpA outcome measures were compared between axSpA patients (nr-axSpA and AS combined) with elevated vs normal F-calprotectin, ASCA IgA and IgG, respectively. Results. Elevated F-calprotectin (≥50 mg/kg) was observed in 27% of nr-axSpA patients, 38% of AS patients and 6% of controls. F-calprotectin was significantly higher in AS vs nr-axSpA [AS: geometric mean 41 (95% CI 32, 54) mg/kg; nr-axSpA: 24 (95% CI 16, 38) mg/kg; P = 0.037], and in each axSpA subtype vs controls. Overall, worse disease activity and physical function scores were observed among axSpA patients with elevated vs normal F-calprotectin levels, with significant differences regarding patient's visual analogue scale for global health, ASDAS using CRP, and BASFI (adjusted for age, sex, NSAID use, anti-rheumatic treatments, and CRP). ASCA titres and seropositivity (≥10 U/ml) were similar in nr-axSpA (IgA/IgG-seropositivity: 8%/26%) and AS (7%/28%), and clinical outcome measures did not differ between patients with elevated vs normal ASCA IgA or IgG, respectively. Compared with controls (IgA/IgG-seropositivity: 0%/17%), ASCA IgA was significantly higher in both axSpA subtypes, and IgG was significantly higher in the AS group. Conclusion. In patients with axSpA, gut inflammation measured by elevated F-calprotectin is associated with worse disease activity and physical function, and may be a marker of more severe disease.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Ankylosing spondylitis, Calprotectin, Gut inflammation, Inflammatory bowel disease, Non-radiographic axial spondyloarthritis, Spondyloarthritis
in
Rheumatology (United Kingdom)
volume
58
issue
7
pages
12 pages
publisher
Oxford University Press
external identifiers
  • scopus:85068459267
ISSN
1462-0324
DOI
10.1093/rheumatology/key427
language
English
LU publication?
yes
id
f8f9defd-57e2-4fed-9ff0-0340e4bb2629
date added to LUP
2019-07-16 15:06:47
date last changed
2019-08-06 03:24:35
@article{f8f9defd-57e2-4fed-9ff0-0340e4bb2629,
  abstract     = {<p>Objectives. To examine faecal calprotectin (F-calprotectin) levels and presence of anti-Saccharomyces cerevisiae antibodies (ASCA) and their associations with disease subtype and current status in axial SpA (axSpA). Methods. F-calprotectin and ASCA in serum were compared between consecutive patients with a clinical axSpA diagnosis, classified as non-radiographic axSpA (nr-axSpA; n = 40) or AS (n = 90), and with healthy controls (n = 35). Furthermore, standard axSpA outcome measures were compared between axSpA patients (nr-axSpA and AS combined) with elevated vs normal F-calprotectin, ASCA IgA and IgG, respectively. Results. Elevated F-calprotectin (≥50 mg/kg) was observed in 27% of nr-axSpA patients, 38% of AS patients and 6% of controls. F-calprotectin was significantly higher in AS vs nr-axSpA [AS: geometric mean 41 (95% CI 32, 54) mg/kg; nr-axSpA: 24 (95% CI 16, 38) mg/kg; P = 0.037], and in each axSpA subtype vs controls. Overall, worse disease activity and physical function scores were observed among axSpA patients with elevated vs normal F-calprotectin levels, with significant differences regarding patient's visual analogue scale for global health, ASDAS using CRP, and BASFI (adjusted for age, sex, NSAID use, anti-rheumatic treatments, and CRP). ASCA titres and seropositivity (≥10 U/ml) were similar in nr-axSpA (IgA/IgG-seropositivity: 8%/26%) and AS (7%/28%), and clinical outcome measures did not differ between patients with elevated vs normal ASCA IgA or IgG, respectively. Compared with controls (IgA/IgG-seropositivity: 0%/17%), ASCA IgA was significantly higher in both axSpA subtypes, and IgG was significantly higher in the AS group. Conclusion. In patients with axSpA, gut inflammation measured by elevated F-calprotectin is associated with worse disease activity and physical function, and may be a marker of more severe disease.</p>},
  author       = {Olofsson, Tor and Lindqvist, Elisabet and Mogard, Elisabeth and Andréasson, Kristofer and Marsal, Jan and Geijer, Mats and Kristensen, Lars Erik and Wallman, Johan K.},
  issn         = {1462-0324},
  keyword      = {Ankylosing spondylitis,Calprotectin,Gut inflammation,Inflammatory bowel disease,Non-radiographic axial spondyloarthritis,Spondyloarthritis},
  language     = {eng},
  month        = {07},
  number       = {7},
  pages        = {1176--1187},
  publisher    = {Oxford University Press},
  series       = {Rheumatology (United Kingdom)},
  title        = {Elevated faecal calprotectin is linked to worse disease status in axial spondyloarthritis : Results from the SPARTAKUS cohort},
  url          = {http://dx.doi.org/10.1093/rheumatology/key427},
  volume       = {58},
  year         = {2019},
}