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Rheumatology Advance Access originally published online on June 6, 2008
Rheumatology 2008 47(8):1219-1222; doi:10.1093/rheumatology/ken148
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Association of markers of bone- and cartilage-degradation with radiological changes at baseline and after 2 years follow-up in patients with ankylosing spondylitis

D. Vosse1,2, R. Landewé1,2, P. Garnero3,4, D. van der Heijde1,2,5, S. van der Linden1,2 and P. Geusens1,2,6

1Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, 2CAPHRI Research Institute, University Maastricht, Maastricht, The Netherlands, 3INSERM Research Unit 664, 4Synarc, Molecular Markers, Lyon, France, 5Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands and 6Biomedical Research Institute, University Hasselt, Hasselt, Belgium.

Correspondence to: D. Vosse, Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: dvo{at}sint.azm.nl


  Abstract

Objective. There is a lack of knowledge on factors that reliably can predict radiological changes in patients with AS. We have investigated whether urinary C-terminal cross-linking telopeptide of type I (CTX-I) and type II (CTX-II) collagen, as specific biochemical markers of bone and cartilage degradation, respectively, are associated with radiological damage and progression, and with BMD in patients with AS.

Methods. Eighty-three patients with AS [mean (S.D.) age: 50.4 (12) yrs, 65% male, mean (S.D.) disease duration after diagnosis: 16.7 (10) yrs] who participate in an ongoing cohort study of patients with AS [Outcome in AS International Study (OASIS) cohort] were assessed for urinary CTX-I and -II. Results of both biochemical markers were compared with baseline scores for radiological damage (modified modified Stoke Ankylosing Spondylitis Spine Score, primarily reflecting syndesmophyte-formation and -growth), and with scores for radiological progression after 2 yrs follow-up. Markers were also associated with disease activity parameters and BMD.

Results. Mean duration of complaints was 28.6 yrs. At that time, 54% of patients had signs of radiological damage, and 35% of them showed radiological progression after 2 yrs. Baseline radiological damage ({rho} = 0.24; P ≤ 0.05) correlated with CTX-II, but not with CTX-I. CTX-II correlated with serological markers of inflammation (ESR {rho} = 0.29 and CRP {rho} = 0.30; P ≤ 0.01), but not with baseline BASDAI or BMD. There was a negative correlation between CTX-I and BMD of the trochanter ({rho} = –0.31; P ≤ 0.01) In multivariate analyses, CTX-II significantly and independently contributed to explaining variation in radiological damage (standardized β = 0.27; P = 0.03) and progression (standardized β = 0.27; P = 0.05).

Conclusion. In AS, cartilage degradation plays a role in explaining radiological-damage and -progression in the spine.

KEY WORDS: Ankylosing spondylitis, Biochemical markers, Bone degradation, Cartilage degradation, Radiological damage, Radiological progression

Submitted 20 September 2007; revised version accepted 20 March 2008.
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