－S 337 －
― F-429 ―
Serum calprotectin as a useful indicator of disease activity and severity in adult-onset still's disease
Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine
*Sang-Youn Jung, Yoo-Jung Ha, Kwang-Hoon Lee, Yong-Beom Park, Soo-Kon Lee
Objectives: This study was performed to investigate whether serum calprotectin levels are increased in patients with adult-onset Still’s disease (AOSD) and whether its levels correlate well with disease activity and severity of AOSD. Methods: Twenty-five patients with AOSD and 30 age- and sex-matched healthy control subjects were enrolled in this cross-sectional study. Thirty-one serum samples were obtained from patients with AOSD during active or inactive disease status, and 30 serum samples were also obtained from controls. Their serum calprotectin levels were quantitatively measured by enzyme-linked immunosorbent assay (ELISA). Clinical and laboratory data related to disease activity and severity were collected at the time serum samples were obtained, and systemic scores for the evaluation of AOSD clinical severity were calculated. Results: Patients with AOSD had a significantly higher mean calprotectin level than controls (54.15 ± 23.72 ng/mL versus 34.90
± 4.85 ng/mL, p<0.05). In AOSD patients, patients with active disease status had a significantly higher mean calprotectin level than those with inactive status (61.26 ± 25.59 ng/mL versus 39.22 ± 7.48 ng/mL, p<0.05). In 6 patients with AOSD, serum calprotectin levels were markedly decreased after high- dose steroid treatment. Serum calprotectin levels showed strong correlations with serum ferritin (r=0.925, p<0.001), lactate dehydrogenase (LDH) (r=0.914, p<0.001), leukocyte count (r=0.745, p<0.001), aspartate aminotransferase (AST) (r=0.631, p<0.001) and C-reactive protein (CRP) levels (r=0.449, p<0.05), but not with erythrocyte sedimentation rate (ESR), arginine aminotransferase (ALT), hemoglobin level or platelet count. Serum calprotectin levels also showed significant correlations with AOSD systemic scores reflecting disease severity (r=0.631, p<0.01). Conclusions: Serum calprotectin levels were increased in patients with AOSD and correlated well with disease activity and severity. These findings suggest that serum calprotectin can be used as a valuable marker of disease activity and severity in AOSD.
― F-430 ―
Acute phase response following intravenous pamidronate infusion
Division of Rheumatology, Department of Internal medicine, Inha University, Incheon, Korea
*Mie Jin Lim, Won Park, Seong Ryul Kwon, Sang Gu Kim, Min Jung Sohn
Purpose: Bisphosphonates(BPs) are widely used for treatment of osteoporosis. They are administered at various interval of a day, a week, a month, 3-months or a year. Longer the interval is more convenient to take the medication. Typical adverse musculoskeletal event such as transient myalgia accompanied by fever has been problem and acute phase response causing these side effects is reported mostly on dose for malignancy. The aim of this study is whether pamidronate, a bisphophonate, induces the acute phase response even on the dose for osteoporosis. Experimental design: Twenty one patients with osteoporosis were selected and they were all given 30mg of intravenous pamidronate. Acute phase reactants such as erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) measurements were taken at baseline and at 24, 48, and 72 hours. Serum level of cytokines inducing acute phase response were measured at baseline and 48 hours. WBC and calcium level were also compared from baseline to few days after pamidronate infusion. Results: At baseline the CRP level was in normal range but the serum level of CRP taken after pamidronate administration began to increase and reached the peak at 72 hours after pamidronate infusion. Its rise for 3 days were all significant (p=0.000). The serum level of ESR was concurrently measured as CRP but its rise was not significant as that of CRP (p=0.057). Serum levels of TNF-α taken after pamidronate administration showed significant change compared to baseline (p=0.031) while serum level of IL-6 marginally increased. WBC slightly decreased (p=0.26) and serum calcium also tended to decrease (p=0.07) Conclusion: This study shows that pamidronate even on the dose for osteoporosis is associated with an acute phase response characterized by an increase in CRP and TNF-α. The acute phase response could be reduced by daily oral low dose of bisphophonate or slower infusion rate of IV bisphophonate.
