Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Bone and cartilaginous metabolites such as matrix metalloproteinase 3 (MMP-3), cartilage oligomeric matrix protein (COMP),receptor activator for nuclear factor κ B ligand (RANKL) and osteoprotegerin (OPG) have the potential to act as biomarkers in rheumatoid arthritis (RA) management. Objective To investigate the clinical utility of bone and cartilage biomarkers in a DMARD-naïve early RA cohort in predicting response to 6 months of therapy with synthetic DMARDs.
Methods: 140 patients with DMARD-naïve early RA (symptoms less than 2 years) were recruited as part of the GREAT study (previously reported[i]).Disease activity was measured at baseline and six months after therapy using the SDAI. Baseline serum MMP-3, COMP, RANKL and OPG were assayed (ELISA).
Results: The majority of patients were of black ethnicity (88.5%) and female (79.2%) with a median age of 47.8 (IQR 14.4). The median symptom duration was 9.7 months (11.4).Rheumatoid factor and ACPA were positive in 81.4% and 84.1% respectively.(Table 1) The median SDAI improved significantly from a median of 41.4 (n=140, IQR 24.1) to 16.4(n=104, IQR 14.8).Baseline MMP 3 and COMP levels were previously reportedi. Baseline RANKL and OPG were elevated in 20.4 and 38.8 % of patients respectively. The sRANKL/OPG ratio was elevated in 56.3% of patients. Only elevated MMP 3 (p=0.048) and OPG (p=0.016) levels at baseline were statistically significantly associated with a moderate or higher disease activity (SDAI > 11) at 6 months .
|% or IQR|
|Black ethnicity (%)||124.0||88.5|
|Age in years, median (IQR)||47.8||14.4|
|Symptom duration in months, median (IQR)||
|Rheumatoid factor positive (%)||114.0||81.4|
|ACPA [n=126] (%)||106.0||84.1|
Conclusion: Outcome measure of low disease activity (SDAI<11) within 3 to 6 months ofdisease onset is the therapeutic target in the management of patients with RA. The measurement of serum MMP 3 has performed well as a biomarker in RA having been incorporated into a multi-biomarker assay. In this study, similar to findings elsewhere, low levels of OPG predicted better control of disease activity at 6 months.[ii]Thus, patients with elevated baseline MMP 3 and OPG may be a subgroup of poor responders requiring aggressive management. These biomarkers may be particularly useful in resource poor settings where regular monitoring aimed at tight control and biologic therapy is widely unavailable. References
[i]Mahmood M. T. M. Ally,et al. Serum Matrix Metalloproteinase-3 in Comparison with Acute Phase Proteins as a Marker of Disease Activity and Radiographic Damage in Early Rheumatoid Arthritis. Mediators of Inflammation,Volume 2013 (2013)
[ii]Van Steenbergen, et al. “Osteoprotegerin as biomarker for persistence of rheumatoid arthritis.” Rheumatology (2015): kev415.
To cite this abstract in AMA style:Meyer P, ally MM, Hodkinson B, Musenge E, becker P, Tikly M, Anderson R. Serum MMP-3 and OPG As Predictors of Response to Traditional Dmards in a Treatment NaïVe Early Rheumatoid Arthritis Cohort [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/serum-mmp-3-and-opg-as-predictors-of-response-to-traditional-dmards-in-a-treatment-naive-early-rheumatoid-arthritis-cohort/. Accessed December 2, 2020.
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