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Calprotectin as a marker of inflammation in patients with early rheumatoid arthritis.

  • Jonsson, Maria Karolina1, 2
  • Sundlisæter, Nina Paulshus2
  • Nordal, Hilde Haugedal1, 3
  • Hammer, Hilde Berner2
  • Aga, Anna-Birgitte2
  • Olsen, Inge Christoffer2
  • Brokstad, Karl Albert3
  • van der Heijde, Désirée2, 4
  • Kvien, Tore K2
  • Fevang, Bjørg-Tilde Svanes1, 3
  • Lillegraven, Siri2
  • Haavardsholm, Espen A2, 5
  • 1 Bergen Group of Epidemiology and Biomarkers in Rheumatic Diseases, Department of Rheumatology, Haukeland University Hospital, Bergen, Norway. , (Norway)
  • 2 Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. , (Norway)
  • 3 Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway. , (Norway)
  • 4 Leiden University Medical Center, Leiden, The Netherlands. , (Netherlands)
  • 5 Institute of Health and Society, University of Oslo, Oslo, Norway. , (Norway)
Published Article
Annals of the Rheumatic Diseases
Publication Date
Dec 01, 2017
DOI: 10.1136/annrheumdis-2017-211695
PMID: 28814431


Calprotectin is an inflammatory marker of interest in rheumatoid arthritis (RA). We evaluated whether the level of calprotectin was associated with disease activity, and if it was predictive of treatment response and radiographic progression in patients with early RA. Plasma from disease-modifying antirheumatic drug (DMARD)-naïve patients with RA fulfilling 2010 American College of Rheumatology/European League Against Rheumatism classification criteria with symptom duration <2 years was analysed for calprotectin at baseline, and after 1, 3 and 12 months. All patients received treat-to-target therapy, as part of a randomised controlled strategy trial (ARCTIC). The association between calprotectin, erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) and measures of disease activity were assessed by correlations. We used likelihood ratios and logistic regression models to assess the predictive value of the baseline inflammatory markers for treatment response and radiographic damage. 215 patients were included: 61% female, 82% anti-citrullinated peptide antibody positive, mean (SD) age 50.9 (13.7) years and median (25, 75 percentile) symptom duration 5.8 (2.8, 10.5) months. Calprotectin was significantly correlated with Clinical Disease Activity Index (r=0.32), ESR (r=0.50) and ultrasonography power Doppler (r=0.42) before treatment onset. After 12 months of treatment, calprotectin, but not ESR and CRP, was significantly correlated with power Doppler (r=0.27). Baseline levels of calprotectin, ESR and CRP were not predictive of treatment response, but high levels of calprotectin were associated with radiographic progression in multivariate models. Calprotectin was correlated with inflammation assessed by ultrasound before and during DMARD treatment, and was also associated with radiographic progression. The data support that calprotectin may be of interest as an inflammatory marker when assessing disease activity in different stages of RA. NCT01205854; Post-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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