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Elevated calprotectin levels reveal bowel inflammation in spondyloarthritis

Heleen Cypers (UGent) , Gaëlle Varkas (UGent) , Sam Beeckman (UGent) , Karlijn Debusschere (UGent) , T Vogl, J Roth, Michael Drennan (UGent) , M Lavric, D Foell, Claude Cuvelier (UGent) , et al.
(2016) ANNALS OF THE RHEUMATIC DISEASES. 75(7). p.1357-1362
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Abstract
Introduction: Microscopic bowel inflammation is present in up to 50% of patients with spondyloarthritis (SpA) and is associated with more severe disease. Currently no reliable biomarkers exist to identify patients at risk. Calprotectin is a sensitive marker of neutrophilic inflammation, measurable in serum and stool. Objectives: To assess whether serum and faecal calprotectin in addition to C-reactive protein (CRP) can be used to identify patients with SpA at risk of microscopic bowel inflammation. Methods: Serum calprotectin and CRP were measured in 125 patients with SpA. In 44 of these patients, faecal samples were available for calprotectin measurement. All 125 patients underwent an ileocolonoscopy to assess the presence of microscopic bowel inflammation. Results: Microscopic bowel inflammation was present in 53 (42.4%) patients with SpA. Elevated serum calprotectin and CRP were independently associated with microscopic bowel inflammation. Faecal calprotectin was also significantly higher in patients with microscopic bowel inflammation. Patients with CRP and serum calprotectin elevated had a frequency of bowel inflammation of 64% vs 25% in patients with low levels of both. When either CRP or serum calprotectin was elevated, the risk was intermediate (40%) and measuring faecal calprotectin provided further differentiation. Hence we suggest a screening approach where initially serum calprotectin and CRP are assessed and, if necessary, faecal calprotectin. The model using this scenario provided an area under the ROC curve of 74.4% for detection of bowel inflammation. Conclusions: Calprotectin measurements in stool and serum, in addition to CRP, may provide a promising strategy to identify patients with SpA at risk of bowel inflammation and could play a role in overall patient stratification.
Keywords
DISEASE-ACTIVITY, ARTHRITIS, GUT INFLAMMATION, FECAL CALPROTECTIN, ANKYLOSING-SPONDYLITIS, INTESTINAL INFLAMMATION, BINDING PROTEINS MRP8, AXIAL SPONDYLOARTHRITIS, SERUM, EXPRESSION

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MLA
Cypers, Heleen, Gaëlle Varkas, Sam Beeckman, et al. “Elevated Calprotectin Levels Reveal Bowel Inflammation in Spondyloarthritis.” ANNALS OF THE RHEUMATIC DISEASES 75.7 (2016): 1357–1362. Print.
APA
Cypers, H., Varkas, G., Beeckman, S., Debusschere, K., Vogl, T., Roth, J., Drennan, M., et al. (2016). Elevated calprotectin levels reveal bowel inflammation in spondyloarthritis. ANNALS OF THE RHEUMATIC DISEASES, 75(7), 1357–1362.
Chicago author-date
Cypers, Heleen, Gaëlle Varkas, Sam Beeckman, Karlijn Debusschere, T Vogl, J Roth, Michael Drennan, et al. 2016. “Elevated Calprotectin Levels Reveal Bowel Inflammation in Spondyloarthritis.” Annals of the Rheumatic Diseases 75 (7): 1357–1362.
Chicago author-date (all authors)
Cypers, Heleen, Gaëlle Varkas, Sam Beeckman, Karlijn Debusschere, T Vogl, J Roth, Michael Drennan, M Lavric, D Foell, Claude Cuvelier, Martine De Vos, Joris Delanghe, Filip Van den Bosch, and Dirk Elewaut. 2016. “Elevated Calprotectin Levels Reveal Bowel Inflammation in Spondyloarthritis.” Annals of the Rheumatic Diseases 75 (7): 1357–1362.
Vancouver
1.
Cypers H, Varkas G, Beeckman S, Debusschere K, Vogl T, Roth J, et al. Elevated calprotectin levels reveal bowel inflammation in spondyloarthritis. ANNALS OF THE RHEUMATIC DISEASES. 2016;75(7):1357–62.
IEEE
[1]
H. Cypers et al., “Elevated calprotectin levels reveal bowel inflammation in spondyloarthritis,” ANNALS OF THE RHEUMATIC DISEASES, vol. 75, no. 7, pp. 1357–1362, 2016.
@article{7175811,
  abstract     = {Introduction: Microscopic bowel inflammation is present in up to 50% of patients with spondyloarthritis (SpA) and is associated with more severe disease. Currently no reliable biomarkers exist to identify patients at risk. Calprotectin is a sensitive marker of neutrophilic inflammation, measurable in serum and stool. 
Objectives: To assess whether serum and faecal calprotectin in addition to C-reactive protein (CRP) can be used to identify patients with SpA at risk of microscopic bowel inflammation. 
Methods: Serum calprotectin and CRP were measured in 125 patients with SpA. In 44 of these patients, faecal samples were available for calprotectin measurement. All 125 patients underwent an ileocolonoscopy to assess the presence of microscopic bowel inflammation. 
Results: Microscopic bowel inflammation was present in 53 (42.4%) patients with SpA. Elevated serum calprotectin and CRP were independently associated with microscopic bowel inflammation. Faecal calprotectin was also significantly higher in patients with microscopic bowel inflammation. Patients with CRP and serum calprotectin elevated had a frequency of bowel inflammation of 64% vs 25% in patients with low levels of both. When either CRP or serum calprotectin was elevated, the risk was intermediate (40%) and measuring faecal calprotectin provided further differentiation. Hence we suggest a screening approach where initially serum calprotectin and CRP are assessed and, if necessary, faecal calprotectin. The model using this scenario provided an area under the ROC curve of 74.4% for detection of bowel inflammation. 
Conclusions: Calprotectin measurements in stool and serum, in addition to CRP, may provide a promising strategy to identify patients with SpA at risk of bowel inflammation and could play a role in overall patient stratification.},
  author       = {Cypers, Heleen and Varkas, Gaëlle and Beeckman, Sam and Debusschere, Karlijn and Vogl, T and Roth, J and Drennan, Michael and Lavric, M and Foell, D and Cuvelier, Claude and De Vos, Martine and Delanghe, Joris and Van den Bosch, Filip and Elewaut, Dirk},
  issn         = {0003-4967},
  journal      = {ANNALS OF THE RHEUMATIC DISEASES},
  keywords     = {DISEASE-ACTIVITY,ARTHRITIS,GUT INFLAMMATION,FECAL CALPROTECTIN,ANKYLOSING-SPONDYLITIS,INTESTINAL INFLAMMATION,BINDING PROTEINS MRP8,AXIAL SPONDYLOARTHRITIS,SERUM,EXPRESSION},
  language     = {eng},
  number       = {7},
  pages        = {1357--1362},
  title        = {Elevated calprotectin levels reveal bowel inflammation in spondyloarthritis},
  url          = {http://dx.doi.org/10.1136/annrheumdis-2015-208025},
  volume       = {75},
  year         = {2016},
}

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