The Expression And Clinical Significance Of Serum Sclerostin In Patients With Rheumatoid Arthritisits

Objective:To investigate the expression levels and clinical significance of serum sclerostin in patients with rheumatoid arthritisits.Methods:Sixty-one RA patients who met the RA classification criteria established by the American College of Rheumatology(ACR)in 1987 and were first diagnosed but untreated by the Rheumatology and Immunology Department of our hospital from September 2017 to May 2019 were selected as the RA group.According to the X-ray staging standard of RA,RA patients were divided into non-bone erosion group(X-ray stage I,n=26)and bone erosion group(X-ray stage II?III?IV,n=35);56 healthy controls were selected.Serum sclerostin?Procollagen type I N-terminal propeptide(PINP)and?-C-terminal telopeptide of type I collagen(?-CTX)concentrations were determined by Enzyme-Linked ImmunoSorbent Assay,Using DXA to detect the bone mineral density including lumbar spine(L1-L4),femoral neck(N),and Ward's triangle(W);Calculate the disease activity index(DAS28-ESR score)of RA patients.The SPSS 23.0 statistical software was applied for data analysis,and P<0.05was considered statistically significant.Results:Serum sclerostin level(16.24±4.15)ng/ml in RA group was significantly higher than that in control group(13.12±3.62)ng/ml(t=4.182,P=0.000);(2)In the RA group,Serum sclerostin level in the bone erosion group(17.56±3.25)ng/ml was higher than that in the non-bone erosion group(14.46±3.40)ng/ml(t=-3.607,P=0.001);(3)BMD in RA group[including lumbar spine(L1-L4)(0.82±0.15)g/cm~2,femoral neck(N)(0.68±0.11)g/cm~2,and Ward's triangle(W)(0.59±0.12)g/cm~2]were lower than that in the control group[(1.10±0.12)g/cm~2?(0.90±0.12)g/cm~2?(0.85±0.11)g/cm~2](t=-11.00,t=-10.44,t=-12.04,P<0.05);(4)BMD in the bone erosion group includes lumbar spine(L1-L4)(0.79±0.15)g/cm~2,femoral neck(N)(0.64±0.11)g/cm~2,and Ward's triangle(W)(0.55±0.11)g/cm~2 were lower than that in non-bone Erosion group[(0.90±0.13)g/cm~2,(0.74±0.11)g/cm~2,(0.64±0.10)g/cm~2](t=2.975,t=3.377,t=3.027),P<0.05);(5)PINP(47.35±14.04)ng/ml in the RA group was lower than that in the control group(60.21±16.07)ng/ml(t=-4.44,P=0.000),?-CTX(5.31±1.91)pg/ml in the RA group was higher than that in the control group(3.55±1.43)pg/ml(t=5.45,P=0.000);(6)Serum sclerostin level was positively correlated with ESR(r=0.383,P=0.003)and CRP(r=0.281,P=0.033)?DAS28 score(r=0.383,P=0.003);There was no correlation between serum sclerostin level and age?course of disease?RF?anti-CCP?IL-6(P>0.05);(7)Serum sclerostin level and BMD(L1-L4)(r=-0.620,P=0.000),BMD(N)(r=-0.349,P=0.008),BMD(W)(r=-0.452,P=0.000),PINP(r=-0.274,P=0.047)were negatively correlated,and positively correlated with?-CTX(r=0.415,P=0.002).(8)ROC curve analysis shows that the AUC of serum sclerostin level to diagnose RA with bone erosion was 0.751(95%CI:0.625~0.876,P=0.001),The cut-off level is 15.33ng/mL,its sensitivity is 85.7%,and its specificity is61.5%.Conclusion:1.The BMD of RA patients was deceased,of which those with bone erosion are more obvious,compared with the control group,the PINP level of RA patients decreased and the?-CTX level increased,suggesting that RA patients have increased bone resorption and inhibited bone formation,resulting in bone loss and secondary OP.2.The level of sclerostin in the serum of RA patients is significantly increased,and the expression can increase with disease activity;sclerostin is negatively correlated with BMD and PINP,and positively correlated with?-CTX,suggesting that the loss of bone mass in RA patients may be related to the high level of sclerostin promoting bone resorption and inhibiting bone formation.sclerostin is expected to become a monitoring indicator of RA with bone metabolism abnormality,and provide new ideas for the early detection and intervention of RA secondary OP.3.The level of serum sclerostin in RA patients with bone erosion was higher than that in patients without bone erosion,which has certain diagnostic value for RA bone erosion.