| ObjectiveTo detect serum levels of Peroxisome proliferater-activated receptor?(PPAR?)in patients with spondyloarthropathies(SpA)and to investigate the relationship between serum PPAR?levels and SpA disease activity,imaging of sacroiliac joint.To compare the clinical characteristics of AS and nr-ax SpA.MethodsA total of 149 patients with SpA from the Department of Rheumatology,the first Affiliated Hospital of Anhui Medical University were enrolled from April 2013 to July2015.And 88 normal subjects during the same period were selected as the control group.The level of serum PPAR?concentration was detected by Enzyme-Linked Immunosorbent Assay(ELISA).149 patients with SpA are all fulfilled the classification criteria for axial spondyloarthritis(axSpA)published by Assessment of Spondylo Arthritis international Society(ASAS)in 2009.And 93 cases were diagnosed as AS according to the 1984 revised New York classification for AS,thirty-one cases with nr-ax SpA which didn't satify with the 1984 revisied New York classification standard but met with the SpA feature,and also had imaging evidence that the performance of the sacroiliac arthritis or with negative imaging but with positive HLA-B27.Twenty-five patients were classified as peripheral SpA which did not meet the axSpA and predominantly represented withperipheral symptoms.All the clinical and laboratory indexes of SpA patients include course of disease,swelling joint counts,tenderness joint counts,patient global assessment(PGA),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),occiput to wall,thoracic expansion,finger to ground distance and Schiber'test were recorded in details.Bath Ankylosing Spondylitis Disease Activity Index(BASDAI),AS Disease Activity Score(ASDAS)and Bath Ankylosing Spondylitis Functional Index(BASFI)calculated in the meantime.One hundred and twenty-nine patients were conducted with examination of magnetic resonance imaging of sacroiliac joint and SPARCC scores were performed.Seum levels of PPAR?in 31 SpA patients before and after therapy were measured.Results1.The median concentration of PPAR?in serum was 119.99(101.53-127.20),which was significant higher than that in the control group 23.38(14.88-35.74)(z=12.596,P<0.001).Serum PPAR?level in 149 patients with SpA was above 54.24ng/ml(P95)in147 patients,the positive rate was 99.3%(147/149),while only 4 cases in the control group with all 88 patients were higher than 54.24ng/ml,the positive rate was4.5%(4/88).Differences of positive rate between the two groups had statistically significant(?~2=270.289,P=0.0001).2.In this study,149 patients with SpA were composed of 93 patients with AS,31patients with nr-ax SpA and 25 patients with peripheral SpA.There were significant differences among three groups on the concentration of serum PPAR?,course of disease,tenderness index,occipitut wall distance,Schober'test,finger to ground distance,BASDAI score,ASDAScrp score,BASFI score(P<0.05-0.0001).There were no significant difference about the number of joint swelling,number of joint tenderness,ESR,CRP and SPARCC scores(P>0.05).There were statistical differences on the concentration of PPAR?,BASDAI score,ASDAScrp score,PGA,occipital wall distance,finger to ground distance,Schober'test,BASFI score between AS patients and nr-ax SpA patients(P<0.05-0.0001).There were no significant differences regarding SPARCC score and sacroiliac joint bone marrow edema between the two groups(P>0.05).3.According to BASDAI score(4 or?4),SpA were divided into group with disease remission and group with disease activity.Results showed that serum PPAR?concentration between different groups was the same(P>0.05).SpA with ASDAScrp<1.3,1.3?ASDAScrp<2.1,2.1?ASDAScrp?3.5,ASDAScrp>3.5 are defined as remission,low activity,high activity,hyperactivity,respectively.Serum PPAR?levels among groups with different disease activity were obviously different(P=0.029).The highest serum concentration of PPAR?in the hyperactivity group was124.67ng/ml.After combing some groups,patients with SpA were divided into following groups:low and moderate activity group(ASDAScrp?3.5)and high activity group(ASDAScrp>3.5),and there was significant difference about serum concentration of PPAR?between the two groups(P=0.016).Patients were divided into two groups according to the SPARCC score(SPARCC>0 or SPARCC=0,SPARCC?6 or SPARCC?5),there was no significant difference on serum PPAR?concentration between the two groups(P>0.05).According to MRI examination of fat deposition at sacroiliac joint(with fat deposition or not),SpA patients were divided into two groups.The concentration of serum PPAR?(124.04 ng/ml)in the fatdeposition free group was higher than that in the fat deposition group(117.57ng/ml)(P=0.041).There was no significant difference on serum PPAR?concentration between groups with positive and negative HLA-B27 or ESR or CRP.(P>0.05).4.There were no significant differences about serum PPAR?concentration between AS groups with BASDAI low activity and severe activity,with and without fat deposition group,SPARCC=0 and above 0,SPARCC?5 and?6,HLA-B27 positive and negative,ESR positive and negative,CRP positive and negative(P>0.05).Among groups with disease remission,low and moderate activity,high activity,extremely high activity,the differences of serum PPAR?levels were statistically different(x~2=7.939,P=0.047).There was also obvious different about serum PPAR?levels between AS patients groups with low and moderate activity(ASDAScrp?3.5)and high activity(ASDAScrp>3.5)(z=2.170,P=0.03).AS patients were divided into the remission group,low and moderate activity group and high activity group,the differences of PPAR?among three groups were also statistically different(x~2=7.515,P=0.023).There were not different about disease activity indexes between groups with nr-axSpAand peripheral SpA(P>0.05).5.According to the different performance of the MRI examination of sacroiliac joint,129 patients with SpA were divided into groups of simple edema,simple fat deposition,edema plus fat deposition.Serum PPAR?of concentration was significantly different among above groups(P=0.001).The concentration of PPAR?in edema plus fat deposition group was the highest,and the median was 123.00ng/ml,followed by simple edema group and the lowest in fat deposition group.There was significant different on SPARCC score and PGA(P<0.05)among three groups,the highest were in the edema group,followed by edema plus fat deposition group and the lowest were in fat deposition group.There was also significant different between the three groups on ESR,and the highest was in edema plus fat deposition group,followed by simple edema group and lowest in fat deposition group(P<0.05).According to the different performance of the MRI examination of sacroiliac joint.there were no significant differences about PPAR?concentration among the three groups with 70 AS patients,(P<0.05),and other characteristics and activity indexes among three groups were the same(P>0.05).6.SpA with serum PPAR?concentration?108.48ng/ml(2 times of normal value)was defined as positive group,less than 108.48ng/ml was defined as negative group,there were no significant differences on clinical and laboratory parameters including age,course of disease,joint tenderness,joint swelling,occiput wall distance,finger to ground distance,CRP,ESR,BASDAI,ASDAICRP and SPARCC scores between PPAR positive group and negative group(P>0.05).7.Serum PPAR?levels was negatively correlated with number of joint swollen(r=-0.205,P<0.05)and joint swelling index(r=-0.201,P<0.05).There was no significant correlations between serum PPAR?and other clinical indexes of SpA(P>0.05).8.ESR,BASDAI,ASDAIcrp and PGA in SpA after treatment were significantly lower than those before treatment(P<0.05),but there was not significant different on serum concentration of PPAR?between SpA before treatment and after treatment(P>0.05).ConclusionOverall characteristics between AS and nr-ax SpA patients are similar,there is different on inflammatory indexes.Serum level of PPAR?in SpA patients were significantly higher than normal control,it was correlated with disease activity and imaging performance of inflammation in SpA. |
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