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      The Relationship between Plasma Pentraxin 3 and Serum Amyloid P Levels and Disease Activity in Ankylosing Spondylitis

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          Abstract

          Background

          In clinical practice, it is hard to judge the level of disease activity in some patients with ankylosing spondylitis (AS) who have low traditional acute phase reactant values such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) but have considerable pain and inflammation. The aim of this study is to investigate plasma pentraxin 3 (PTX3) and serum amyloid P (SAP) levels in patients with AS who had normal ESR and CRP but high disease activity.

          Methods

          100 AS patients and 100 gender- and age-matched controls were included. Epidemiological, clinical, and treatment data and plasma levels of CRP, ESR, PTX3, and SAP were evaluated. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP were used for evaluating disease activity. Plasma levels of PTX3 and SAP were compared between AS patients and controls and also among AS patients with active and inactive disease.

          Results

          AS patients had significantly higher plasma levels of PTX3 and SAP than controls. There were not any significant correlations between PTX3 and SAP with BASDAI, ASDAS-CRP, and ESR. There was a positive correlation between PTX3 and CRP. No significant difference in plasma levels of PTX3 and SAP was observed between patients with active disease and inactive disease, both with normal ESR and CRP levels. Disease duration and treatment did not influence plasma PTX3 levels.

          Conclusions

          In patients with AS, plasma levels of PTX3 and SAP were found to be elevated when compared to healthy controls. No association was observed between these biomarkers and disease activity.

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          Most cited references20

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          The pentraxins PTX3 and SAP in innate immunity, regulation of inflammation and tissue remodelling.

          Pentraxins are a superfamily of fluid phase pattern recognition molecules conserved in evolution and characterized by a cyclic multimeric structure. C-reactive protein (CRP) and serum amyloid P component (SAP) constitute the short pentraxin arm of the superfamily. CRP and SAP are produced in the liver in response to IL-6 and are acute phase reactants in humans and mice respectively. In addition SAP has been shown to affect tissue remodelling and fibrosis by stabilizing all types of amyloid fibrils and by regulating monocyte to fibrocyte differentiation. Pentraxin 3 (PTX3) is the prototype of the long pentraxin arm. Gene targeted mice and genetic and epigenetic studies in humans suggest that PTX3 plays essential non-redundant roles in innate immunity and inflammation as well as in tissue remodelling. Recent studies have revealed the role of PTX3 as extrinsic oncosuppressor, able to tune cancer-related inflammation. In addition, at acidic pH PTX3 can interact with provisional matrix components promoting inflammatory matrix remodelling. Thus acidification during tissue repair sets PTX3 in a tissue remodelling and repair mode, suggesting that matrix and microbial recognition are common, ancestral features of the humoral arm of innate immunity.
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            Measuring disease activity in ankylosing spondylitis: patient and physician have different perspectives.

            There is no "gold standard" to assess disease activity in patients with ankylosing spondylitis (AS). It is known that patients and physicians have different opinions about disease activity. The objective was therefore to investigate on which criteria patients with AS and physicians base their judgement on disease activity. A cohort of 203 AS out-patients fulfilling the modified New York criteria included in the ongoing long-term follow-up was analysed. The Assessment in Ankylosing Spondylitis (ASAS) International Working Group has established different domains relevant for outcome in AS. Each domain includes a number of instruments for making assessments, and all these instruments are included in the Outcome in Ankylosing Spondylitis International Study and were made every 6 months for 2 yr. Disease activity from the patient perspective as well as from the physician perspective was analysed using the patient's or the physician's global assessment of disease activity [visual analogue scale (VAS): 0 (best)-10 (worst)] by dichotomizing into "high disease activity" (VAS > or = 6.0) and "low disease activity" (VAS < or = 4.0). Data reduction by principal components analysis (PCA) was performed to distinguish factors capturing correlated instruments. Discriminant analysis with the factor loadings was performed to discriminate between a low and a high disease activity state from both the patient's and the physician's perspective. Multiple regression analysis on the discriminant scores was performed to prioritize the instruments. PCA revealed four factors: spinal mobility, physician assessments, patient assessments and laboratory assessments (Cronbach's alpha 0.52-0.80; explained variance 61%). Discriminant function analysis showed that the factor "patient assessments" was most important (pooled correlation 0.85) in discriminating between a low and a high disease activity state as defined by the patient. The other three factors contributed marginally (pooled correlation <0.30). In contrast, the factors "physician's assessments" (pooled correlation 0.62), "spinal mobility" (pooled correlation 0.52) and "laboratory assessments" (pooled correlation 0.48) contributed most to the physician's perspective. The factor "patient assessments" did not contribute at all (pooled correlation 0.05). Multivariate analysis on the discriminant scores showed that the instruments "pain spine", "BASFI", "pain joints" and "BASDAI fatigue" explained more than 90% of variance in the case of the patient perspective. The instruments "cervical rotation", "swollen joint count", "CRP" and "intermalleolar distance" explained more than 90% of variance in case of physician perspective. AS patients rate disease activity on the basis of complaints while physicians rate disease activity on the basis of instruments related to disease severity and inflammation.
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              Diagnosis and management of ankylosing spondylitis.

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                Author and article information

                Contributors
                Journal
                Int J Clin Pract
                Int J Clin Pract
                IJCLP
                International Journal of Clinical Practice
                Hindawi
                1368-5031
                1742-1241
                2022
                24 March 2022
                : 2022
                : 7243399
                Affiliations
                1Gaziler Physical Therapy and Rehabilitation Training and Research Hospital, Clinic of Rheumatology, Ankara, Turkey
                2Ankara City Hospital, Clinic of Rheumatology, Ankara, Turkey
                3Aydın State Hospital, Clinic of Rheumatology, Aydın, Turkey
                4Memorial Şişli Hospital, Clinic of Rheumatology, İstanbul, Turkey
                5ErzurumRegional Training and Research Hospital, Clinic of Physical Therapy and Rehabilitation, Erzurum, Turkey
                6Ankara University, Faculty of Medicine, Department of Immunology and Allergy, Ankara, Turkey
                7Ankara University, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Ankara, Turkey
                8Ankara University, Faculty of Medicine, Department of Physical and Rehabilitation Medicine, Division of Rheumatology, Ankara, Turkey
                Author notes

                Academic Editor: Pier P. Sainaghi

                Author information
                https://orcid.org/0000-0001-9174-1792
                https://orcid.org/0000-0003-1965-9756
                https://orcid.org/0000-0002-4435-5677
                https://orcid.org/0000-0002-0686-0904
                https://orcid.org/0000-0003-1216-2667
                https://orcid.org/0000-0002-5256-6765
                https://orcid.org/0000-0003-0426-1200
                https://orcid.org/0000-0003-3570-3825
                Article
                10.1155/2022/7243399
                9159165
                3de1ea4a-2beb-4d44-9b36-92401c74957f
                Copyright © 2022 Ali Erhan Özdemirel et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 4 November 2021
                : 7 March 2022
                : 9 March 2022
                Categories
                Research Article

                Medicine
                Medicine

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