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Added value of biomarkers compared with clinical parameters for the prediction of radiographic spinal progression in axial spondyloarthritis.

Author information

Affiliations

  • 1. Department of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin.
      Authors
    • Rademacher J 1, 3
    • Tietz LM 1, 3
    • Hartl A 1, 3
    • Sieper J 1, 3
    • Rudwaleit M 1, 3
    • Poddubnyy D 1, 3
    (6 authors)
  • 2. Institute of Medical Informatics, Biometry, and Epidemiology, Ludwig-Maximilian University, Munich.
      Authors
    • Le L 2
    • Mansmann U 2
    (2 authors)
  • 3. Berlin Institute of Health, Berlin.
      Authors
    • Rademacher J 1, 3
    • Tietz LM 1, 3
    • Hartl A 1, 3
    • Hermann KA 3
    • Sieper J 1, 3
    • Rudwaleit M 1, 3
    • Poddubnyy D 1, 3
    (7 authors)

ORCIDs linked to this article

Rheumatology (Oxford, England), 01 Sep 2019, 58(9):1556-1564
https://doi.org/10.1093/rheumatology/kez025 PMID: 30830164 

A comment on this article appears in "Using combinations of biomarkers to understand inflammation and bone formation in axial spondyloarthritis - is anything better than CRP?" Rheumatology (Oxford). 2019 Sep 1;58(9):1517-1519.

Abstract 

Objectives

The objective of this study was to examine whether adding biomarkers to routine clinical parameters improves prediction of radiographic spinal progression in axial spondyloarthritis.

Methods

One hundred and seventeen patients with ankylosing spondylitis who completed the Effects of NSAIDs on RAdiographic Damage in Ankylosing Spondylitis (ENRADAS) trial were included. Radiographic spinal progression was defined as worsening of the modified Stoke Ankylosing Spondylitis Spine Score by ⩾2 points after 2 years. A clinical prediction model was constructed out of baseline syndesmophytes, elevated CRP, cigarette smoking and male sex. The following serum biomarkers were measured at baseline by ELISA: MMP3, VEGF, calprotectin, leptin, high molecular weight adiponectin, osteoprotegerin, sclerostin, N-terminal telopeptide, procollagen type II N-terminal propeptide and serum amyloid A.

Results

Repeated cross-validation analyses revealed one biomarker combination with potential added predictive value in addition to the clinical model: leptin + high molecular weight adiponectin + VEGF. This biomarker combination showed an area under the curve (AUC)Biomarkers = 0.731 (95% CI: 0.614, 0.848), which was numerically superior to the clinical model [AUCClinical = 0.665 (95% CI: 0.553, 0.776)]. A combination of clinical parameters + biomarkers showed an improved predictive value compared with the clinical model reflected by AUCClinical+Biomarkers = 0.768 (95% CI: 0.666, 0.871), though not statistically significant (P = 0.051). However, by considering the part of the receiver operating characteristic curve with a specificity ⩾75% resulting in partial AUC (pAUC), the improvement becomes significant (pAUCClinical+Biomarkers = 0.119; pAUCClinical = 0.053; P = 0.01).

Conclusion

Biomarkers show potential to improve the prediction of radiographic spinal progression in axial spondyloarthritis when used in addition to the clinical parameters, though the added value seems to be rather small.

Full text links 

Read article at publisher's site: https://doi.org/10.1093/rheumatology/kez025

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Funding 

Funders who supported this work.

ArthroMark (1)

BMBF (1)

Berlin Institute of Health

    Bundesministerium für Bildung und Forschung – BMBF

      German Ministry of Education and Research

        METARTHROS (1)