Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Calprotectin is a major S100 leucocyte protein, is associated to disease activity in rheumatoid arthritis (RA) and Psoriatic Arthritis (PsA) patients. Calprotectin is a potentially biomarker more sensitive of disease activity than conventional acute-phase proteins.
Objective: To analyze the relationship between calprotectin serum levels and inflammatory disease activity in patients with RA and PsA patients in clinical remission or low disease activity treated with TNF-antagonists. To correlate calprotectin levels with serum trough levels of TNF-antagonists.
Methods: Prospective cohort study of patients diagnosed with RA (ACR 1987 criteria) or PsA (CASPAR criteria) treated with adalimumab (ADA), etanercept (ETN) or infliximab (IFX) for ≥ 3 months in clinical remission or with low disease activity measured by DAS28-ESR in ≥ 2 consecutive visits. Clinical and laboratory data were analyzed. Calprotectin serum levels (using kits from Calpro AS, Norway) and TNF-antagonist serum trough levels, anti-drug antibodies (Abs) (using kits from Promonitor®, Progenika SA) were determined at 0, 4, 8 and 12 months of follow-up. We present the results at study entry (visit 0).
Results: 103 patients (47 RA, 56 PsA) were included. 61% female, mean age 58±12 years, mean DAS28-ESR 2.1±0.58, 76% were in clinical remission and 24% in low disease activity, 48% on monotherapy, 44% receiving reduced dosage of biologic (ADA 18 patients, ETN 22 patients and IFX 5 patients). Calprotectin levels were significantly lower in PsA than in RA patients (1.4±1 vs. 2.2±1, p=0.006). Patient on clinical remission (DAS28<2.6) showed lower calprotectin levels to those observed in those with low disease activity (1.2±1 vs. 3.4±1, p<0.0001), even when distributed by the most stringent remission criteria (patients with SDAI <3.3 1.4±1 vs. SDAI>3.3 1.9±2, p=0.005). Calprotectin strongly correlates with DAS28-ESR and SDAI in both RA (rs=0.744, p<0.0001 and rs=0.328, p=0.025 respectively) and PsA (rs=0.777, p<0.0001 and rs=0.419, p=0.001 respectively), whereas no correlation was found between CRP serum levels or ESR with DAS28-ESR and SDAI in both populations. A trend for higher calprotectin levels in patients with low serum trough levels of ADA was showed (n=17, rs=-0.413, p=0.09), that was statistically significant in those patients with RA treated with adalimumab at standard dose (rs=-0.767, p=0.026). No correlations between calprotectin and serum trough levels ETN or IFX were observed.
Conclusion: Calprotectin was found to have high accuracy to discriminate RA or PsA patients in remission from those in low disease activity undergoing TNF-antagonists therapy, reflecting ongoing inflammatory activity. A strong correlation between disease activity measured by DAS28 and SDAI and calprotectin, but not with CRP or ESR, was found. No clear correlation between calprotectin levels and TNF-antagonists serum through levels was observed. Calprotectin emerges as a very useful biomarker to detect residual inflammatory activity in these patients.
Disclosure:
J. Inciarte-Mundo,
Premi Fi de Residencia “Emili Letang”,
2,
Beca MSD Societat Catalana de Reumatologia,
2;
M. V. Hernández,
None;
S. Cabrera-Villalba,
None;
J. Ramirez,
None;
A. Cuervo,
None;
V. Ruiz-Esquide,
None;
A. González Navarro,
None;
J. Yagüe,
None;
J. D. Cañete,
None;
R. Sanmarti,
unrestricted educational grant from Pfizer,
2.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/calprotectin-serum-levels-reflect-residual-inflammatory-activity-in-patients-with-rheumatoid-arthritis-and-psoriatic-arthritis-on-clinical-remission-or-low-disease-activity-undergoing-tnf-antagonists/