ORIJINAL ARAŞTIRMA
Ankilozan Spondilit Hastalarında Kemik Formasyonu Üzerine Etki Eden Potansiyel Belirteçlerin Serum Düzeylerinin Radyolojik Progresyon ve Hastalık Aktivasyonu ile İlişkisi
The Relationship of Serum Levels of Potential Biomarkers Affecting Bone Formation with Radiological Progression and Disease Activation in Patients with Ankylosing Spondylitis
Received Date : 25 Jul 2022
Accepted Date : 12 Aug 2022
Available Online : 18 Aug 2022
Ali Erhan ÖZDEMİRELa Serdar Can GÜVENb, Alper DOĞANCIc, Ayşe Peyman YALÇIN SAYINd, Hüseyin TUTKAKe, Şebnem ATAMANf
aClinic of Rheumatology, Liv Hospital, Ankara, Türkiye
bClinic of Rheumatology, Ministry of Health Ankara City Hospital, Ankara, Türkiye
cClinic of Physical Therapy and Rehabilitation, Erzurum Regional Training and Research Hospital, Erzurum, Türkiye
dDepartment of Physical and Rehabilitation Medicine, Ankara University Faculty of Medicine, Ankara, Türkiye
eDepartment of Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Türkiye
fDepartment of Physical and Rehabilitation Medicine, Division of Rheumatology, Ankara University Faculty of Medicine, Ankara, Türkiye
Doi: 10.31609/jpmrs.2022-92597 - Makale Dili: EN
J PMR Sci. 2022;25(3):377-85
ÖZET
Amaç: Bu çalışmada, ankilozan spondilit (AS) hastalarında radyografik progresyona
ve hastalık aktivitesine katkıda bulunabilecek Dickkopf-1, sclerostin, kemik
morfogenetik protein [bone morphogenetic protein (BMP)]-2 ve 4, interlökin (IL)-17 ve
23 düzeylerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmamız kesitsel
tarzda olup, 238 AS hastası ve 102 kişiden oluşan, yaş ve cinsiyet yönünden
eşleştirilmiş kontrol grubu üzerinde yapılmıştır. Hastaların çalışmaya dâhil edildiği andaki
hastalık aktivitesi, Bath Ankilozan Spondilit Hastalık Aktivite İndeksi [Bath Ankylosing
Spondylitis Disease Activity Index (BASDAI)] ile değerlendirildi. Hasta ve
kontrol gruplarında Dickkopf-1, BMP-2 ve 4, sclerostin, IL-17 ve 23’ün kandaki seviyeleri
ölçüldü. Hastaların radyografik değerlendirmesi, modifiye Stokes Ankilozan
Spondilit Spinal Skoru (mSASSS) esas alınarak hesaplandı. Bulgular: AS hastalarının
serum Dickkopf-1, sclerostin, IL-17 ve 23 seviyeleri kontrol grubuna göre anlamlı derecede
yüksekti. Serum BMP-4 düzeyleri açısından fark bulunmazken, BMP-2 düzeyleri
kontrol grubunda anlamlı olarak yüksekti (p<0,001). mSASSS ortalaması 4,4±6,2 olup,
varyans analizi ile tüm faktörler kontrol altına alınarak yapılan değerlendirmede, biyobelirteçlerin
tek başına bu skoru etkilemediği belirlendi. Ancak ortanca değerlerin üzerindeki
BMP-2 ve 4 değerleri birlikte mSASSS’yi %3,3 etkilemiştir (p=0,017).
Korelasyon analizinde BASDAI ile BMP-4 arasında zayıf, negatif anlamlı bir korelasyon
bulundu (p<0,05). Sonuç: AS’de radyografik ilerlemeye katkıda bulunan birçok
inflamatuar ve inflamatuar olmayan yol vardır. Hem literatürdeki veriler hem de
çalışmamızın sonuçları, progresyona katkıda bulunabilecek belirteçlerin serum seviyelerinden
ziyade lokal seviyedeki düzey ve işlevselliğinin önemine işaret etmektedir.
Anahtar Kelimeler: Ankilozan spondilit; Dickkopf-1; sclerostin; kemik morfogenetik protein; modifiye Stokes Ankilozan Spondilit Spinal Skoru
ABSTRACT
Objective: To determine the levels of Dickkopf-1, sclerostin, bone morphogenetic
protein (BMP) -2 and 4, interleukin (IL)-17 and 23, which might contribute
to the radiographic progression and disease activity in ankylosing spondylitis (AS). Material
and Methods: A cross-sectional study was carried out on 238 AS patients and
age and sex-matched control group of 102 individuals. The disease activity was assessed
through the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). In
both groups Dickkopf-1, BMP-2 and 4, sclerostin, IL-17 and 23 levels were measured.
Radiographic changes were calculated based on the modified Stokes Ankylosing
Spondylitis Spinal Score (mSASSS). Results: Dickkopf-1, sclerostin, IL-17 and 23 levels
were significantly higher in AS group compared to the controls. There was no difference
regarding serum BMP-4 levels, whereas BMP-2 levels were significantly higher
in the control group (p<0.001). Mean mSASSS was 4.4±6.2 and it was determined that
biomarkers alone did not affect this score in the evaluation made by taking all factors
under control by variance analysis. However, BMP-2 and 4 values together above the
median values affected the mSASSS by 3.3% (p=0.017). In the correlation analysis, a
weak negative significant correlation was found between BASDAI and BMP-4
(p<0.05). Conclusion: There are many inflammatory and non-inflammatory pathways
that contribute to radiographic progression in ankylosing spondylitis. Both the data in
the literature and the results of our study point to the importance of the local level and
functionality of markers that may contribute to progression rather than serum levels.
Keywords: Ankylosing spondylitis; Dickkopf-1; sclerostin; bone morphogenetic protein; modified Stokes Ankylosing Spondylitis Spinal Score
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