| Markers of collagen metabolism in the assessment of rheumatoid arthritis.: With special reference to cross-linked carboxyterminal telopeptide of type I collagen (ICTP) | ||
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There are markers of collagen metabolism that can be measured in serum and synovial fluid to provide an assessment of the disease process in patients with RA. Hitherto, ICTP and PIIINP have been the most informative.
According to the results of this study, which mainly focused on patients with RA, synovial fluid analysis may help in assessing the disease process of a particular joint in patients with inflammatory arthritis. The results indicate that a high SF leukocyte level is not necessarily associated with a poor prognosis. Instead, a high SF-ICTP level seems to reflect accelerated radiological progression of the assessed joint.
An elevated serum ICTP level in patients with advanced RA seems to discriminate between cases with mild and destructive joint disease and the need for total joint replacement surgery.
In discordance with the previous findings of early RA, generalized osteoporosis was rarely seen during the first two years. The possible explanatory factors are that the present series was community-based and the patients had predominantly mild disease, were actively treated and showed no deterioration of their their physical function. Against this background, the power of the markers of type I collagen metabolism to reflect BMD changes could not be tested.
Initially elevated serum ICTP combined with either RF positivity or increased CRP may serve as a predictive combination for an aggressive disease course in early RA.