Ankilozan spondilit hastalarında wingless / beta-katenin inhibitörlerinin serum düzeyi ve anti-tümör nekrozis faktör alfa tedavileri ile ilişkisi

Amaç: Bu çalışmadaki öncelikli amacımız ankilozan spondilit (AS) hastalarında ve sağlıklı kontrollerde Dickkopf-1 (DKK-1) ve sklerostinin serum düzeylerini karşılaştırmaktı. İkincil amacımız anti-tümör nekrozis faktör alfa (anti-TNF-a) tedavilerinin DKK-1 ve sklerostinin serum düzeylerine olan etkisini değerlendirmekti. Son olarak AS hastalarında DKK-1, sklerostin düzeyleri ile radyolojik progresyon arasında ilişki olup olmadığını değerlendirmeyi amaçladık.Gereç ve Yöntem: Çalışmamıza 70 AS (35 anti-TNF tedavi alan, 35 anti-TNF almayan) hastası ve 31 sağlıklı kontrol alındı. Hastalarda ve sağlıklı kontrollerde serum DKK-1, sklerostin, C-reaktif protein ve eritrosit sedimentasyon hızı ölçüldü. Ankilozan spondilit hastalık aktivite skoru (ASDAS), Bath ankilozan spondilit hastalık aktivite indeksi (BASDAİ), Bath ankilozan spondilit metroloji indeksi (BASMİ), Bath ankilozan spondilit fonksiyonel indeksi (BASFİ) hesaplandı. Radyografiler hasta bilgilerine körleştirilmiş deneyimli bir radyolog tarafından modifiye stoke ankilozan spondilit spinal skoru (mSASSS) yöntemine göre skorlandı.Bulgular: Anti-TNF-a tedavi alan AS hastalarında BASMI ve mSASSS skorları anti-TNF-a tedavi almayan hastalara göre daha yüksekti. AS hastalarında serum DKK-1 ve sklerostin düzeyleri sağlıklı kontrollere göre daha düşüktü. AS hastalarında DKK-1 düzeyleri ile ASDAS ve BASMİ arasında ters yönlü bir korelasyon vardı. DKK-1 ve sklerostin düzeyleri ile mSASSS arasında korelasyon yoktu. AS hastalarında BASMİ skoru ile mSASSS arasında anlamlı korelasyon vardı.Sonuç: AS hastalarındaki DKK-1 düzeyleri ile BASMİ arasında ters yönlü bir korelasyon vardı, diğer yandan BASMİ ve mSASSS skorları arasında güçlü bir korelasyon vardı. Bu nedenler, bu bulgular AS hastalarındaki düşük DKK-1 seviyelerinin yeni kemik oluşumunda rol oynayabileceğini düşündürmektedir.

Anahtar Kelimeler:

Ankilozan spondilit, Dickkopf-1, sklerostin, anti-tümör nekrozis faktör alfa

Serum levels of inhibitors of wingless / beta-catenin in patients with ankylosing spondylitis and the relationship with anti-tumour necrosis factor alpha treatments

Aim: The primary aim of the study was to compare the serum levels of Dickkopf-1 (DKK-1) and sclerostin in patients with ankylosing spondylitis (AS) and healthy controls. The secondary aim was to evaluate the effects of anti-tumor necrosis factor alpha (TNF-α) treatments on levels of DKK-1 and sclerostin. The last aim was to evaluate any relationship between DKK-1, sclerostin, and radiologic progression in AS.Material and Method: We included 70 patients with AS (35 anti-TNF-α treated, 35 anti-TNF-α naïve) and 31 healthy controls in this study. Serum DKK-1, sclerostin, C reactive protein, and erythrocyte sedimentation rate (ESR) were assessed in patients and healthy controls. The Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), and Bath Ankylosing Spondylitis Functional Index (BASFI) were calculated for the patients. Radiographs were scored according to the modified Stoke AS Spine Score (mSASSS) by an experienced radiologist who was blinded to the patients’ identity.Results: Patients with AS who were treated with anti-TNF-α agent had higher scores of BASMI and mSASSS compared with the anti-TNF-α naïve patients. Serum levels of DKK-1 and sclerostin were significantly lower in patients with AS than in healthy controls. There was a negative correlation between DKK-1 levels with ASDAS and BASMI in patients with AS. There was no correlation between DKK-1 or sclerostin levels with mSASSS. There was a positive correlation between BASMI score with mSASSS in patients with AS.Conclusion: DKK-1 levels in patients with AS were negatively correlated with BASMI, on the other hand, BASMI had a strong positive correlation with mSASSS. Therefore, these findings suggest that lower DKK-1 levels in patients with AS may play a role in new bone formation.

Keywords:

sclerostin, ankylosing spondylitis, dickkopf-1, anti-tumor necrosis factor alpha,

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