Bone Mineral Density and Serum Levels of Bone Remodeling Markers in Ankylosing Spondylitis Treated with Anti TNF-α Agents.

IF 4.4 Q1 Medicine
Efren Gerardo Alvarez-Ayala, Jorge Ivan Gamez-Nava, Ana Miriam Saldaña-Cruz, Fabiola Gonzalez-Ponce, Betsabe Contreras-Haro, Melissa Ramirez-Villafaña, Edsaul Emilio Perez-Guerrero, Miriam Fabiola Alcaraz-Lopez, Eli Efrain Gomez-Ramirez, Juan Manuel Ponce-Guarneros, Norma Alejandra Rodriguez-Jimenez, Sylvia Elena Totsuka-Sutto, Alberto Daniel Rocha-Muñoz, Luis Alfonso Muñoz-Miranda, Laura Gonzalez-Lopez, Cesar Arturo Nava-Valdivia
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引用次数: 0

Abstract

Background: Ankylosing spondylitis (AS) is a chronic autoinflammatory rheumatic disease mainly affecting the sacroiliac joints and spine, causing altered bone remodeling. Pro-inflammatory cytokines such as TNF-α and IL-17 contribute to bone loss by modulating pathways including Wnt/β-catenin, which is inhibited by proteins like Dickkopf-1 (DKK-1) and sclerostin (SOST). Bone morphogenetic protein-6 (BMP-6) promotes osteoblast differentiation and bone formation. This study evaluated the association between serum levels of DKK-1, SOST, BMP-6, and bone mineral density (BMD) in AS patients treated with anti-TNF agents and conventional synthetic DMARDs (csDMARDs). Methods: A cross-sectional study included 76 AS patients diagnosed by modified New York criteria and 30 healthy donors matched by age and sex. BMD at the lumbar spine and hips was assessed by DXA in all participants. Disease activity (BASDAI) and functional index (BASFI) were measured in AS patients. Serum levels of DKK-1, SOST, BMP-6, TNF-α, and IL-17 were quantified by ELISA in both groups. AS patients were divided into two treatment groups: combined anti-TNFα and csDMARD therapy (n = 38), and only csDMARDs (n = 38). Results: Bone mineral density showed no significant statistical differences between the spine (p = 0.930) and hips (p = 0.876) in AS patients compared to healthy controls. The activity (BASDAI) and functionality (BASFI) scores were similar in both treatment groups (p = 0.161 and p = 0.271, respectively). No significant differences were found in serum levels of DKK-1 (p = 0.815), SOST (p = 0.771), BMP-6 (p = 0.451), or IL-17 (p = 0.335) between combined anti-TNFα and csDMARD therapy versus monotherapy with csDMARD. Conclusions: The combination of anti-TNF bDMARD therapy and csDMARD therapy is not significantly associated with serum levels of DKK-1, SOST, BMP-6, and BMD compared to those treated with csDMARD monotherapy in patients with AS. This study provides novel and clinically relevant evidence on how anti-TNF bDMARDs and csDMARDs differentially affect bone turnover biomarkers and bone health in patients with AS, contributing to a better understanding of therapeutic strategies and guiding future research and clinical decision-making.

抗TNF-α治疗强直性脊柱炎患者骨密度及骨重塑标志物的血清水平
背景:强直性脊柱炎(AS)是一种慢性自身炎症性风湿病,主要影响骶髂关节和脊柱,引起骨重塑改变。促炎细胞因子如TNF-α和IL-17通过调节Wnt/β-catenin等途径促进骨质流失,Wnt/β-catenin被Dickkopf-1 (DKK-1)和sclerostin (SOST)等蛋白抑制。骨形态发生蛋白6 (BMP-6)促进成骨细胞分化和骨形成。本研究评估了接受抗tnf药物和常规合成DMARDs (csDMARDs)治疗的AS患者血清DKK-1、SOST、BMP-6水平和骨密度(BMD)之间的关系。方法:一项横断面研究包括76例经修改的纽约标准诊断的AS患者和30例年龄和性别匹配的健康供体。所有参与者的腰椎和髋部骨密度均通过DXA评估。测定AS患者的疾病活动性(BASDAI)和功能指数(BASFI)。ELISA法测定两组患者血清DKK-1、SOST、BMP-6、TNF-α、IL-17水平。将AS患者分为抗tnf α联合csDMARD治疗组(n = 38)和仅csDMARD治疗组(n = 38)。结果:AS患者脊柱骨密度(p = 0.930)和髋部骨密度(p = 0.876)与健康对照组比较,差异无统计学意义。活性(BASDAI)和功能(BASFI)评分在两个治疗组中相似(p = 0.161和p = 0.271)。血清DKK-1 (p = 0.815)、SOST (p = 0.771)、BMP-6 (p = 0.451)或IL-17 (p = 0.335)水平在抗tnf α联合csDMARD治疗与单用csDMARD治疗之间无显著差异。结论:与单用csDMARD治疗相比,抗tnf bDMARD联合csDMARD治疗与AS患者血清DKK-1、SOST、BMP-6和BMD水平无显著相关性。本研究为抗tnf bDMARDs和csDMARDs对AS患者骨转换生物标志物和骨健康的差异提供了新的临床相关证据,有助于更好地理解治疗策略,指导未来的研究和临床决策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
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