Clinical correlation
of potential markers of the systemic scleroderma activity
Bečvář R., Štork J.1, Pešáková V., Stáňová A., Hulejová H., Rysová L.,Zatloukalová A.2, Zatloukal P.3, Jáchymová M.4, Pourová L.4
Revmatologický ústav, Praha,1Dermatovenerologická klinika, VFN, Praha, 2Soukromá plicní ambulance, Praha 5, 3Klinika pneumologie a hrudní chirurgie FN Bulovka, Praha, 4II. interní klinika, VFN, Praha |
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Summary:
Systemic scleroderma (SSc) is a disease characterized by vascular damage, skin and internal organ
connective tissue thickening or fibrosis. Variability of clinical symptoms, chronic course of the
disease and little value of acute-phase reactant measurement, all contribute to the lack of specific
markers for the disease activity, which would help with indication of treatment and further follow
up of SSc. The aim of this study was to verify if some selected factors could serve as SSc activity
markers. Clinical correlations of potential markers of disease activity, determined in a group of SSc
patients at the start of the study and after 1 year were compared. In total 49 patients were examined
– 36 with limited, 9 with diffuse and 4 with other forms of SSc. The circulating levels of N-terminal
propeptide of procollagen type III (PNPIIIP), interleukin-6 (IL-6), soluble interleukin-2 receptor
(sIL2-R), intercellular adhesion molecule-1 (sICAM-1), vascular adhesion molecule (sVCAM-1), of von
Willebrands factor antigen (vWFAg), big endothelin-1 (BET-1), and urine excretion of pyridinoline
(PYR)anddeoxypyridinoline (D-PYR)were determined.Then the correlations of these markers with
clinical data reflecting activity and with functional questionnaire (FQ) were measured. The mean
levels ofsICAM-1,sVCAM-1,vWFAg,sIL-2R,BET-1 andPYRwerenot significantly elevatedcompared
with normal levels. Concentration of NPIIIP, D-PYR and IL-6 were normal. No significant difference
was found in the levels of any of these markers at control measurement after 1 year. The level of
NPIIIP correlated with the finger to palm (FTP) distance as well as with D-PYR concentration and
FQ. IL-6 levels correlated with leukocyte count, sIL-2R and FQ. The same correlations were found
for NPIIIP and D-PYR after 1 year. IL-6 levels and FQ, even sIL-2Rand erythrocyte count correlated.
BET-1 concentration and decreased DLCO correlated. Correlations of collagen turnover markers
with skin damage indicators and with FQ, conforming with literature data, support their possible
use for monitoring of fibrotic changes. Correlation of endothelial markers damage with activation
of the immune system will have to be verified in larger studies.
Key words:
systemic sclerosis, activity, collagen, adhesion molecules, interleukins, endothelin
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