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Serum sclerostin in adult high-activity patients with juvenile idiopathic arthritis

04 Oct 2014

IntroductionJuvenile idiopathic arthritis (JIA) is a disease associated with loss of bone mass, deterioration in its quality, and an increased risk of fractures. The objective of this study was to evaluate factors that predict bone mineral density (BMD) alterations in young adult patients with active JIA, before and during therapy with tumour necrosis factor alpha (TNF?) inhibitors.
Thirty-one patients (12 males and 19 females aged 25.1???6.1?years) with active JIA (disease activity score 28 (DAS 28) 6.36???0.64; high-sensitivity C-reactive protein (hsCRP) 18.36???16.95?mg/l) were investigated. The control group consisted of 84 healthy individuals of matched gender and age. Bone mineral density, bone turnover markers, and serum concentrations of soluble receptor activator of nuclear factor kappa B ligand, osteoprotegerin, dickkopf-1 (Dkk1), and sclerostin were evaluated.
Baseline BMD values in the lumbar spine, proximal femur, femoral neck and distal radius were significantly lower in JIA patients compared to healthy controls. Baseline sclerostin serum concentrations were significantly higher in JIA patients compared to controls. After two years of treatment with TNF? inhibitors, BMD significantly increased in the lumbar spine. This increase correlated with a drop in DAS 28 score. A statistically significant correlation between hsCRP and Dkk1 was found at baseline, as well as during the 2-year follow-up period. A significant reduction in serum sclerostin after one year of therapy predicted a drop in DAS 28 score observed with a one-year delay after reduction of serum sclerostin.
A significant correlation between the sclerostin serum concentration and the number of tender and swollen joints, but not BMD, supports the hypothesis that chondrocytes and cells of the subchondral bone may contribute to circulating sclerostin in JIA.

Click here to view the full article which appeared in Arthritis Research & Therapy