Calprotectin as a marker of disease activity in spondyloarthritis
DOI:
https://doi.org/10.33178/SMJ.2019.1.8Keywords:
spondyloarthritis, calprotectin, bowel inflammation, SpA, disease activityAbstract
Introduction: Spondyloarthritis is a group of arthritic diseases that classically manifest as inflammation of the sacroiliac and limb joints, as well as the axial skeleton. Microscopic bowel inflammation is identifiable in over 50% of these patients. Calprotectin measured in the serum and stool is an emerging surrogate marker of disease activity and/or bowel inflammation in spondyloarthritis.
Objective: This article aims to review published literature to determine the accuracy of serum and faecal calprotectin levels for use in monitoring bowel inflammation and spondyloarthritis disease activity.
Methods: Boolean operator strategy was used to search two databases (Embase and PubMed) and 52 relevant articles were identified. Duplicate results were eliminated, inclusion and exclusion criteria were applied.
Results: Ten studies met the inclusion criteria and were summarized and analyzed. The EBL Validity questionnaire was applied to determine study quality. All research articles found calprotectin to be elevated in spondyloarthritis patients when compared to controls. Faecal calprotectin was superior in detecting disease activity and correlated with disease activity questionnaires, radiology and endoscopy results. Only one study assessed the effect of treatment on calprotectin and its correlation to bowel inflammation.
Conclusion: Faecal calprotectin shows promise as a surrogate marker for disease activity and bowel inflammation in spondyloarthritis. Future studies should focus on the effect of treatment on faecal calprotectin and whether some treatments are better at preventing the progression of bowel inflammation in addition to treating spondyloarthritis. Supplementary investigations are needed to identify whether faecal calprotectin is useful as a marker of disease activity in response to treatment.
References
Khan MA. Update on spondyloarthropathies. Annals Of Internal Medicine. 2002;136(12):896-907.
Taurog JD, Chhabra A, Colbert RA. Ankylosing Spondylitis and Axial Spondyloarthritis. N Engl J Med. 2016;374(26):2563-74.
Cuvelier C, Barbatis C, Mielants H, De Vos M, Roels H, Veys E. Histopathology of intestinal inflammation related to reactive arthritis. Gut. 1987;28(4):394-401.
De Vos M, Mielants H, Cuvelier C, Elewaut A, Veys E. Long-term evolution of gut inflammation in patients with spondyloarthropathy. Gastroenterology. 1996;110(6):1696-703.
Van Praet L, Jans L, Carron P, Jacques P, Glorieus E, Colman R, et al. Degree of bone marrow oedema in sacroiliac joints of patients with axial spondyloarthritis is linked to gut inflammation and male sex: results from the GIANT cohort. Ann Rheum Dis. 2014;73(6):1186-9.
Cypers H, Varkas G, Beeckman S, Debusschere K, Vogl T, Roth J, et al. Elevated calprotectin levels reveal bowel inflammation in spondyloarthritis. Ann Rheum Dis. 2016;75(7):1357-62.
D'Angelo F, Felley C, Frossard JL. Calprotectin in Daily Practice: Where Do We Stand in 2017? Digestion. 2017;95(4):293-301.
Madland TM, Hordvik M, Haga HJ, Jonsson R, Brun JG. Leukocyte protein calprotectin and outcome in rheumatoid arthritis. A longitudinal
study. Scand J Rheumatol. 2002;31(6):351-4.
Klingberg E, Carlsten H, Hilme E, Hedberg M, Forsblad-d'Elia H. Calprotectin in ankylosing spondylitis--frequently elevated in feces, but normal in serum. Scand J Gastroenterol. 2012;47(4):435-44.
Matzkies FG, Targan SR, Berel D, Landers CJ, Reveille JD, McGovern DP, et al. Markers of intestinal inflammation in patients with ankylosing spondylitis: a pilot study. Arthritis Res Ther. 2012;14(6):R261.
Oktayoglu P, Bozkurt M, Mete N, Caglayan M, Em S, Nas K, et al. Elevated serum levels of calprotectin (myeloid-related protein 8/14) in patients with ankylosing spondylitis and its association with disease activity and quality of life Markers of intestinal inflammation in patients with ankylosing spondylitis: a pilot study. J Investig Med. 2014;62(6):880-4.
Duran A, Kobak S, Sen N, Aktakka S, Atabay T, Orman M. Fecal calprotectin is associated with disease activity in patients with ankylosing spondylitis. Bosn J Basic Med Sci. 2016;16(1):71-4.
Turina MC, Yeremenko N, van Gaalen F, van Oosterhout M, Berg IJ, Ramonda R, et al. Serum inflammatory biomarkers fail to identify early axial spondyloarthritis: results from the SpondyloArthritis Caught Early (SPACE) cohort. RMD Open. 2017;3(1):e000319.
Klingberg E, Strid H, Stahl A, Deminger A, Carlsten H, Ohman L, et al. A longitudinal study of fecal calprotectin and the development of inflammatory bowel disease in ankylosing spondylitis. Arthritis Res Ther. 2017;19 (1):21.
Kopylov U, Starr M, Watts C, Dionne S, Girardin M, Seidman EG, et al. Detection of Crohn Disease in Patients with Spondyloarthropathy: The SpACE Capsule Study- A longitudinal study of fecal calprotectin and the development of inflammatory bowel disease in ankylosing spondylitis. J Rheumatol. 2018;45(4):498-505.
Ostgard RD, Deleuran BW, Dam MY, Hansen IT, Jurik AG, Glerup H. Faecal calprotectin detects subclinical bowel inflammation and may predict treatment response in spondyloarthritis. Scand J Rheumatol. 2018;47(1):48-55.
Olofsson T, Lindqvist E, Mogard E, Andreasson K, Marsal J, Geijer M, et al. Elevated faecal calprotectin is linked to worse disease status in axial spondyloarthritis: results from the SPARTAKUS cohort. Rheumatology (Oxford). 2019.
Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S47-58.
Striz I, Jaresova M, Lacha J, Sedlacek J, Vitko S. MRP 8/14 and procalcitonin serum levels in organ transplantations. Ann Transplant. 2001;6(2):6-9.
Stockley RA, Dale I, Hill SL, Fagerhol MK. Relationship of neutrophil cytoplasmic protein (L1) to acute and chronic lung disease. Scand J Clin Lab Invest. 1984;44(7):629-34.
Striz I, Trebichavsky I. Calprotectin - a pleiotropic molecule in acute and chronic inflammation. Physiol Res. 2004;53(3):245-53.
Gouveia EB, Elmann D, Morales MS. Ankylosing spondylitis and uveitis: overview. Rev Bras Reumatol. 2012;52(5):742-56.
Tibble JA, Sigthorsson G, Foster R, Scott D, Fagerhol MK, Roseth A, et al. High prevalence of NSAID enteropathy as shown by a simple faecal test. Gut. 1999;45(3):362-6.
Danese S, Vuitton L, Peyrin-Biroulet L. Biologic agents for IBD: practical insights. Nat Rev Gastroenterol Hepatol. 2015;12(9):537-45.
Reveille JD, Arnett FC. Spondyloarthritis: update on pathogenesis and management. Am J Med. 2005;118(6):592-603.
Fernandez-Carballido C, Navarro-Compan V, Castillo-Gallego C, Castro-Villegas MC, Collantes-Estevez E, de Miguel E. Disease Activity As a Major Determinant of Quality of Life and Physical Function in Patients With Early Axial Spondyloarthritis. Arthritis Care Res (Hoboken). 2017;69 (1):150-5.
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