Continuously elevated serum matrix metalloproteinase-3 for 3 ~ 6 months predict one-year radiographic progression in rheumatoid arthritis: a prospective cohort study

Abstract

IntroductionCore disease activity indicators of rheumatoid arthritis (RA) have been found to be limited in predicting joint destruction progression. Matrix metalloproteinase (MMP) 3 plays an essential role in joint destruction and was found elevated in some remission patients. We aimed to monitor dynamic core disease activity indicators and serum MMP-3 for one year and evaluate their value for predicting radiographic progression.MethodsPatients with active RA (Simplified disease activity index > 3.3) were treated according to the treat-to-target strategy. Serum MMP-3 was detected by enzyme-linked immunosorbent assay and clinical data were collected simultaneously at 0, 1st, 3rd, 6th and 12th month. X-ray assessment of hand/wrist was repeated at baseline and the 12th month and a change of total Sharp score > 0.5 units was defined as radiographic progression.ResultsFifty-six patients completed one year follow-up and 29 % showed radiographic progression. Although not significantly different at baseline, serum MMP-3 and all core disease activity indicators, except for erythrocyte sedimentation rate, at the 12th month were significantly higher in the progressive group than in the non-progressive group. Among sixteen progressive patients, 69 % achieved the therapeutic target and 56 % had continuous elevated serum MMP-3, 38 % had continuous elevated serum MMP-3 and normal C-reactive protein (CRP) at the 6th month. Log-rank tests and repeated measures analysis revealed a significant difference in dynamic serum MMP-3 between progressive and non-progressive patients. Receiver operating characteristic curve and univariate logistic regression analysis showed that elevated serum MMP-3 at 0, 1st, 3rd and 6th months, compared with CRP at the 1st month, were significant predictors for one-year radiographic progression (MMP-3 odds ratio (OR):10.500 ~ 27.000, all P < 0.05; CRP: OR = 7.400, P = 0.011).ConclusionsOur data showed that continuously elevated serum MMP-3 for 3 ~ 6 months predicted one-year radiographic progression which implied that monitoring of dynamic serum MMP-3 combined with core disease activity indicators may be more helpful for predicting radiographic progression and treatment decision in RA.

Factors associated with hand joint destruction in Chinese patients with rheumatoid arthritis

“…In the current study, almost 47.2% of RA patients from Nantong China suffered from hand joint destruction. This prevalence estimate is significantly lower than those observed both in China [39] and other countries [5]. Such discrepancy could be explained that the majority of RA patients included in this study were outpatients with milder disease, which would have led to a lower prevalence estimate.…”

Higher levels of matrix metalloproteinase-3 in patients with RA reflect disease activity and structural damage

“…A recent study demonstrated that low levels of MMP-3 at the onset of the disease predict a patient subgroup that exhibits no radiographic progression over 3-year methotrexate monotherapy and does not require combination therapy 32 . Another study found that continuously elevated serum MMP-3 may predict radiographic evidence of progression over 1 year in patients treated with various DMARDs using a treat-to-target protocol 33 . The above findings are also supported by those by Nawata et al demonstrating that high levels of MMP-3 predict a poor effect of infliximab and radiographic progression, especially in joint space narrowing, with high CRP levels being a negative prognostic factor for joint erosions.…”

Myopenia is associated with joint damage in rheumatoid arthritis: a cross‐sectional study

“…25 Conventional radiographs of bilateral hands and wrists (anteroposterior view) were performed on all RA patients and assessed with the Sharp/van der Heijde modified Sharp score by two experienced observers (C. M. H. from radiology and M. J. D. from rheumatology) who were blinded to clinical data as we described previously. 26 Sixteen areas for joint erosion (JE) and 15 for joint space narrowing (JSN) of hands were assessed in each hand/wrist. The maximum score per single joint for JE is 5 and for JSN is 4, with the sum of JE (0-160) and JSN (0-120) subscores constituting total modified Sharp score (mTSS, 0-280).…”