Pentraxin 3 is a marker of early joint inflammation in patients with juvenile idiopathic arthritis
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DIAGNOSIS OF AUTOIMMUNITY
Pentraxin 3 is a marker of early joint inflammation in patients with juvenile idiopathic arthritis Shai Padeh • Nahid Farzam • Gilad Chayen Maya Gerstein • Yackov Berkun
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Yackov Berkun
Published online: 12 April 2013 Ó Springer Science+Business Media New York 2013
Abstract Pentraxin 3 (PTX3) is an acute phase protein produced in different body tissues. The aims of this study were to characterize PTX3 secretion in synovial fluid (SF) of juvenile idiopathic arthritis (JIA) patients and to analyze the correlation of PTX3 levels in SF with clinical characteristics and the course of the disease. SF-PTX3 levels were measured in a cohort of 75 consecutive JIA patients followed in a single center. Patients’ clinical characteristics, disease course, and therapies were analyzed for their correlation with SF-PTX3 levels. A synovial cell line was used to study the kinetics of PTX3 secretion by synoviocytes. SF-PTX3 levels varied over a wide range. Elevated SF-PTX3 levels were detected in patients who subsequently required treatment with disease-modifying antirheumatic drugs during the follow-up period. SFPTX3 levels were found to be inversely correlated with the length of time from onset of joint swelling. No correlation was found between synovial and serum PTX3 or C-reactive protein (CRP). Following in vitro stimulation of synovial cell line with TNFa or IL1, the secretion of PTX3 increases transiently in the first 48–72 h. A similar increase was obtained in patients’ synovial fluids but not with IL6. Higher SF-PTX3 levels were found when tested closer to arthritis exacerbation and 48–72 h after in vitro stimulation of cells from a synovial cell line, implying that PTX3 plays a role in early stages of inflammation. Higher SF-PTX3 levels were associated with several clinical features reflecting disease severity and prognostic data. Measuring SF-PTX3 levels may help in providing a more focused and patient-adjusted treatment. Keywords Juvenile idiopathic arthritis Children DMARD disease-modifying antirheumatic drugs Intra-articular corticosteroid injection Pentraxin 3 Abbreviations ANA Antinuclear antibody DMARDs Disease-modifying antirheumatic drugs IACSI Intra-articular corticosteroid injections JIA Juvenile idiopathic arthritis MTX Methotrexate
PTX3 SF TNF
S. Padeh N. Farzam G. Chayen M. Gerstein Y. Berkun Department of Pediatrics A, Edmond & Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel
Juvenile idiopathic arthritis (JIA), a clinically heterogeneous group of different disorders characterized by chronic inflammatory arthritis in children, is the most common chronic rheumatic disease of childhood and an important cause of short- and long-term disability [1]. Although the precise etiology is still unknown, JIA is an autoimmune disease, and T cells are believed to be key players in its pathogenesis [2–4]. In many JIA patients, the levels of the classic acute phase reactants such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) a
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