Serum calprotectin (S100A8/A9): a promising biomarker in diagnosis and follow-up in different subgroups of juvenile idiopathic arthritis

Abstract

Introduction: In the management of juvenile idiopathic arthritis (JIA), there is a lack of diagnostic and prognostic biomarkers. This study assesses the use of serum calprotectin (sCal) as a marker to monitor disease activity, and as a classification and prognosis tool of response to treatment or risk of flares in patients with JIA.

Methods: Eighty-one patients with JIA from the CAP48 multicentric cohort were included in this study, as well as 11 non-paediatric healthy controls. An ELISA method was used to quantify sCal with a commercial kit.

Results: Patients with an active disease compared with healthy controls and with patients with inactive disease showed an eightfold and a twofold increased level of sCal, respectively. sCal was found to be correlated with the C-reactive protein (CRP) and even more strongly with the erythrocyte sedimentation rate. Evolution of DAS28 scores correlated well with evolution of sCal, as opposed to evolution of CRP. With regard to CRP, sCal could differentiate forms with active oligoarthritis from polyarthritis and systemic forms. However, sCal brought an added value compared with the CRP as a prognosis marker. Indeed, patients with active disease and reaching minimal disease activity (according to Juvenile Arthritis Disease Activity Score) at 6 months following the test had higher sCal levels, while patients with inactive disease had higher sCal levels if a flare was observed up to 3-9 months following the test.

Conclusions: This study confirms the potential uses of sCal as a biomarker in the diagnosis and follow-up of JIA.

Keywords: health care; inflammation; juvenile idiopathic arthritis; outcome assessment.

Figure 1

Levels of sCal according to disease activity. Results are given as mean±SEM. Statistical significance (*p<0.05, ****p<0.0001) was assessed by Mann-Whitney test. sCal, serum calprotectin.

Figure 2

Levels of sCal or CRP according to clinical subgroups. (A and B) Levels of sCal according to clinical subgroups, with all forms of oligoarthritis grouped (A) or separated according to their categories (B). (C) Levels of CRP according to clinical subgroups. Results are given as mean±SEM (A–C). Statistical significance (*p<0.05, **p<0.01, ****p<0.0001) was assessed by Mann-Whitney test. CRP, C-reactive protein; ERA, enthesitis-related arthritis; OA-E, extended form of oligoarthritis; OA-P, persistent form of oligoarthritis; PA, polyarthritis; sCal, serum calprotectin.

Figure 3

Levels of sCal according to the response to treatment. (A) Levels of sCal in patients with an active disease and starting a new treatment, according to their ability to reach minimal disease activity. (B) Receiver operating characteristic curves of response to treatment according to sCal or CRP. Results are given as mean±SEM (A). Statistical significance (*p<0.05) was assessed by Mann-Whitney test (A). CRP, C-reactive protein; MDA, minimal disease activity; sCal, serum calprotectin.

Figure 4

Levels of sCal according to the risk of flares. (A) Levels of sCal according to the risk of flare among patients in remission. (B) Receiver operating characteristic curves of risk of flares according to sCal or CRP. Results are given as mean±SEM (A). Statistical significance (***p<0.001) was assessed by Mann-Whitney test (A). CRP, C-reactive protein; sCal, serum calprotectin.