Complement system in psoriatic arthritis

A useful marker in response prediction and monitoring of anti-TNF treatment

Maria Sole Chimenti, Carlo Perricone, Dario Graceffa, Gioia Di Muzio, Eleonora Ballanti, Maria Domenica Guarino, Paola Conigliaro, Elisabetta Greco, Barbara Kroegler, Roberto Perricone

Research output: Contribution to journalArticle

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Abstract

Objective: Treatment with anti-TNF agents is well established in psoriatic arthritis (PsA). Anti-TNF agents are capable of modulating complement activity in vitro but there are no data on the in vivo effect. Anti-TNF have high costs and potential risks, thus, there is an urgent need for accurate predictors of response. We aimed at studying the usefulness of erythrocyte-sedimentation rate (ESR), C-reactive protein (CRP), and complement for response prediction and monitoring of anti-TNF treatment in PsA patients. Methods: Fifty-five patients were included consecutively before starting etanercept or adalimumab. ESR, CRP, plasma complement C3, C4, and C3 and B cleavage fragments were evaluated at baseline and after 22 weeks of anti-TNF treatment. Disease activity was measured with DAS28 and response to therapy with EULAR criteria. Complement was evaluated at baseline in 30 healthy subjects as well. Results: At baseline, C3 and C4 levels were significantly higher than in controls (C3 126.9±22 vs. 110±25 mg/dl, p=0.000002; C4 31.2±9.2 vs. 22.7±8.3 mg/dl, p=0.0003). After anti-TNF therapy, C3 and C4 levels were significantly reduced to normalization (p=0.0009 and 0.0005, respectively) and ESR, CRP and DAS28 showed a significant reduction (p=0.002, 0.004 and 0.0001, respectively). Split products of C3 and B were not observed at baseline and after 22 weeks. Higher baseline C3 levels were associated with EULAR non-response (p=0.011). Conclusion: PsA patients with moderate to severe disease show elevated C3 and C4 levels, reverted by anti-TNF treatment. High C3 may be considered a hallmark of inflammation and C3 revealed the highest predictive value for response to anti-TNF.

Original languageEnglish
Pages (from-to)23-30
Number of pages8
JournalClinical and Experimental Rheumatology
Volume30
Issue number1
Publication statusPublished - 2012

Fingerprint

Psoriatic Arthritis
Blood Sedimentation
C-Reactive Protein
Therapeutics
Complement C4
Complement C3
Healthy Volunteers
Inflammation
Costs and Cost Analysis

Keywords

  • Anti-TNF
  • C3
  • Complement
  • Disease activity
  • Psoriatic arthritis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Immunology and Allergy

Cite this

Chimenti, M. S., Perricone, C., Graceffa, D., Di Muzio, G., Ballanti, E., Guarino, M. D., ... Perricone, R. (2012). Complement system in psoriatic arthritis: A useful marker in response prediction and monitoring of anti-TNF treatment. Clinical and Experimental Rheumatology, 30(1), 23-30.

Complement system in psoriatic arthritis : A useful marker in response prediction and monitoring of anti-TNF treatment. / Chimenti, Maria Sole; Perricone, Carlo; Graceffa, Dario; Di Muzio, Gioia; Ballanti, Eleonora; Guarino, Maria Domenica; Conigliaro, Paola; Greco, Elisabetta; Kroegler, Barbara; Perricone, Roberto.

In: Clinical and Experimental Rheumatology, Vol. 30, No. 1, 2012, p. 23-30.

Research output: Contribution to journalArticle

Chimenti, MS, Perricone, C, Graceffa, D, Di Muzio, G, Ballanti, E, Guarino, MD, Conigliaro, P, Greco, E, Kroegler, B & Perricone, R 2012, 'Complement system in psoriatic arthritis: A useful marker in response prediction and monitoring of anti-TNF treatment', Clinical and Experimental Rheumatology, vol. 30, no. 1, pp. 23-30.
Chimenti, Maria Sole ; Perricone, Carlo ; Graceffa, Dario ; Di Muzio, Gioia ; Ballanti, Eleonora ; Guarino, Maria Domenica ; Conigliaro, Paola ; Greco, Elisabetta ; Kroegler, Barbara ; Perricone, Roberto. / Complement system in psoriatic arthritis : A useful marker in response prediction and monitoring of anti-TNF treatment. In: Clinical and Experimental Rheumatology. 2012 ; Vol. 30, No. 1. pp. 23-30.
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abstract = "Objective: Treatment with anti-TNF agents is well established in psoriatic arthritis (PsA). Anti-TNF agents are capable of modulating complement activity in vitro but there are no data on the in vivo effect. Anti-TNF have high costs and potential risks, thus, there is an urgent need for accurate predictors of response. We aimed at studying the usefulness of erythrocyte-sedimentation rate (ESR), C-reactive protein (CRP), and complement for response prediction and monitoring of anti-TNF treatment in PsA patients. Methods: Fifty-five patients were included consecutively before starting etanercept or adalimumab. ESR, CRP, plasma complement C3, C4, and C3 and B cleavage fragments were evaluated at baseline and after 22 weeks of anti-TNF treatment. Disease activity was measured with DAS28 and response to therapy with EULAR criteria. Complement was evaluated at baseline in 30 healthy subjects as well. Results: At baseline, C3 and C4 levels were significantly higher than in controls (C3 126.9±22 vs. 110±25 mg/dl, p=0.000002; C4 31.2±9.2 vs. 22.7±8.3 mg/dl, p=0.0003). After anti-TNF therapy, C3 and C4 levels were significantly reduced to normalization (p=0.0009 and 0.0005, respectively) and ESR, CRP and DAS28 showed a significant reduction (p=0.002, 0.004 and 0.0001, respectively). Split products of C3 and B were not observed at baseline and after 22 weeks. Higher baseline C3 levels were associated with EULAR non-response (p=0.011). Conclusion: PsA patients with moderate to severe disease show elevated C3 and C4 levels, reverted by anti-TNF treatment. High C3 may be considered a hallmark of inflammation and C3 revealed the highest predictive value for response to anti-TNF.",
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