Calprotectin in spondyloarthritis and gut inflammation, is it clinically meaningful?

Spondyloarthritis​(SpA)​describes​a​group​of​interrelated​rheumatic​ disorders​ comprising​ ankylosing​ spondylitis​ (AS),​ psoriatic​ arthritis​ (PsA),​ reactive​ arthritis​ and​ inflammatory​ bowel​ disease​ (IBD)-​ related​arthritis.​The​term​axial​spondyloarthritis​(axSpA)​comprises​ both​ nonradiographic​ (nr-​axSpA)​ and​ radiographic​ axSpA,​ also​ known​as​AS.​Gut​inflammation,​microbe​etiology,​IBD,​and​gastrointestinal​symptoms​(GI)​are​considered​to​be​closely​associated​with​ SpA.1,2 Up​to​20%​of​IBD​patients,​including​those​with​ulcerative​colitis​ and​Crohn's​ disease​ (CD),​ develop​presentations​ including​peripheral​ arthritis,​ anterior​ uveitis,​ and​ sacroiliitis.​ Conversely,​ patients​ with​early​SpA​share​10-​to​100-​fold​higher​odds​of​developing​IBD​ compared​ to​ the​ general​ population,​ proven​ through​ endoscopic​ and​histological​gut​ inflammation.3​The​ risk​of​ this​may​be​significantly​ greater​ once​microscopic​ bowel​ inflammation​ is​ present​ at​ diagnosis.4 Theoretically,​ the​ immunological​ mechanisms​ of​ bowel​ inflammation​ participate​ in​ the​ onset​ of​ joint​ inflammation​ in​ SpA.​ Histologic​ evidence​ demonstrated​ that​ both​ acute​ and​ chronic​ bowel​ inflammation​ are​ intended​ to​ acquire​more​ extensive​ bone​ marrow​ edema​ of​ the​ sacroiliac​ joints​ and​ higher​ risk​ of​ progression​ to​ AS​ and​ developing​ CD.5​ The​ screening​ and​ diagnosis​ are​ often​made​via​endoscopy,​the​invasiveness​of​the​procedure​and​is​ not​routinely​recommended​in​SpA​patients​without​GI​symptoms.​ Additionally,​approximately​half​of​patients​with​SpA​have​normal​C-​ reactive​protein​(CRP)​levels,​limiting​the​diagnostic​value​of​this​biomarker.6​Therefore,​it​is​crucial​to​detect​reliable​diagnostic​markers​ for​the​screening​and​evaluating​treatment​prognosis​of​SpA.

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