Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1995 Jul;54(7):556–559. doi: 10.1136/ard.54.7.556

Evidence of impaired cartilage/bone turnover in patients with active ankylosing spondylitis.

W Marhoffer 1, H Stracke 1, I Masoud 1, M Scheja 1, V Graef 1, W Bolten 1, K Federlin 1
PMCID: PMC1009934  PMID: 7668898

Abstract

OBJECTIVES--To compare serum markers of bone formation with the urinary excretion of pyridinium crosslinks (PYR) as a possible measure of bone and cartilage degradation which would detect changes in bone metabolism in patients with ankylosing spondylitis (AS) and to relate them to influences of inflammatory disease activity, and to treatment. METHODS--In 62 patients with AS, serum osteocalcin, alkaline phosphatase (ALP), and skeletal ALP isoenzyme levels were evaluated concurrently in comparison with urinary excretion of pyridinium cross links and were compared with values in 50 healthy controls. RESULTS--Osteocalcin concentrations in AS patients were in the middle normal range (3.5 (SD 1.2) ng/ml) and did not differ significantly from those in control subjects (4.2 (1.3) ng/ml); the same was true for ALP and skeletal ALP isoenzyme fraction (AS: ALP 149 (50.3) U/l, skeletal ALP 12.8 (4.1) micrograms/l; controls: ALP 133 (25.2) U/l, skeletal ALP 11.9 (4.3) micrograms/l). The urinary levels of PYR in AS (51.2 (25.2) nmol PYR/mmol creatinine) were significantly increased compared with controls (33.9 (12.4) nmol PYR/mmol creatinine (p < 0.001)). In the AS group there was a positive correlation between urinary excretion of PYR and inflammatory disease activity (erythrocyte sedimentation rate (ESR)) (r = 0.6, p < 0.0001) and C reactive protein (CRP) (r = 0.3, p = 0.02), but no significant correlation was found with ESR, CRP, and markers of bone formation. CONCLUSIONS--Bone metabolism in patients with AS is characterised by normal bone formation and enhanced cartilage/bone degradation, suggesting that impaired bone turnover is pronounced in active disease. The results clearly indicate that this comparison can be used to demonstrate impairment of cartilage/bone metabolism which correlates with disease activity. The data obtained further emphasise the importance of measuring both serum variables and urinary excretion of PYR crosslinks to obtain adequate evaluation of cartilage/bone metabolism in patients with AS.

Full text

PDF
556

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Black D., Duncan A., Robins S. P. Quantitative analysis of the pyridinium crosslinks of collagen in urine using ion-paired reversed-phase high-performance liquid chromatography. Anal Biochem. 1988 Feb 15;169(1):197–203. doi: 10.1016/0003-2697(88)90274-6. [DOI] [PubMed] [Google Scholar]
  2. Fishman W. H. Alkaline phosphatase isozymes: recent progress. Clin Biochem. 1990 Apr;23(2):99–104. doi: 10.1016/0009-9120(90)80019-f. [DOI] [PubMed] [Google Scholar]
  3. Franck H., Keck E. Serum osteocalcin and vitamin D metabolites in patients with ankylosing spondylitis. Ann Rheum Dis. 1993 May;52(5):343–346. doi: 10.1136/ard.52.5.343. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fujimoto D., Moriguchi T., Ishida T., Hayashi H. The structure of pyridinoline, a collagen crosslink. Biochem Biophys Res Commun. 1978 Sep 14;84(1):52–57. doi: 10.1016/0006-291x(78)90261-9. [DOI] [PubMed] [Google Scholar]
  5. Hanson C. A., Shagrin J. W., Duncan H. Vertebral osteoporosis in ankylosing spondylitis. Clin Orthop Relat Res. 1971 Jan;74:59–64. [PubMed] [Google Scholar]
  6. Harris H. The human alkaline phosphatases: what we know and what we don't know. Clin Chim Acta. 1990 Jan 15;186(2):133–150. doi: 10.1016/0009-8981(90)90031-m. [DOI] [PubMed] [Google Scholar]
  7. Helfgott S., Rosenthall L., Esdaile J., Tannenbaum H. Generalized skeletal response to 99mtechnetium methylene diphosphonate in rheumatoid arthritis. J Rheumatol. 1982 Nov-Dec;9(6):939–941. [PubMed] [Google Scholar]
  8. Khan M. A., van der Linden S. M. Ankylosing spondylitis and other spondyloarthropathies. Rheum Dis Clin North Am. 1990 Aug;16(3):551–579. [PubMed] [Google Scholar]
  9. Magaro M., Altomonte L., Mirone L., Zoli A., Corvino G. Bone GLA protein (BGP) levels and bone turnover in rheumatoid arthritis. Br J Rheumatol. 1989 Jun;28(3):207–211. doi: 10.1093/rheumatology/28.3.207. [DOI] [PubMed] [Google Scholar]
  10. Marhoffer W., Schatz H., Stracke H., Ullmann J., Schmidt K., Federlin K. Serum osteocalcin levels in rheumatoid arthritis: a marker for accelerated bone turnover in late onset rheumatoid arthritis. J Rheumatol. 1991 Aug;18(8):1158–1162. [PubMed] [Google Scholar]
  11. Moll J. M., Wright V. New York clinical criteria for ankylosing spondylitis. A statistical evaluation. Ann Rheum Dis. 1973 Jul;32(4):354–363. doi: 10.1136/ard.32.4.354. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Price P. A., Parthemore J. G., Deftos L. J. New biochemical marker for bone metabolism. Measurement by radioimmunoassay of bone GLA protein in the plasma of normal subjects and patients with bone disease. J Clin Invest. 1980 Nov;66(5):878–883. doi: 10.1172/JCI109954. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Ralston S. H., Urquhart G. D., Brzeski M., Sturrock R. D. Prevalence of vertebral compression fractures due to osteoporosis in ankylosing spondylitis. BMJ. 1990 Mar 3;300(6724):563–565. doi: 10.1136/bmj.300.6724.563. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Reid D. M., Nicoll J. J., Kennedy N. S., Smith M. A., Tothill P., Nuki G. Bone mass in ankylosing spondylitis. J Rheumatol. 1986 Oct;13(5):932–935. [PubMed] [Google Scholar]
  15. Robins S. P. An enzyme-linked immunoassay for the collagen cross-link pyridinoline. Biochem J. 1982 Dec 1;207(3):617–620. doi: 10.1042/bj2070617. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Robins S. P., Stewart P., Astbury C., Bird H. A. Measurement of the cross linking compound, pyridinoline, in urine as an index of collagen degradation in joint disease. Ann Rheum Dis. 1986 Dec;45(12):969–973. doi: 10.1136/ard.45.12.969. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Slovik D. M., Gundberg C. M., Neer R. M., Lian J. B. Clinical evaluation of bone turnover by serum osteocalcin measurements in a hospital setting. J Clin Endocrinol Metab. 1984 Aug;59(2):228–230. doi: 10.1210/jcem-59-2-228. [DOI] [PubMed] [Google Scholar]
  18. Wicks I. P., Moore J., Fleming A. Australian mortality statistics for rheumatoid arthritis 1950-81: analysis of death certificate data. Ann Rheum Dis. 1988 Jul;47(7):563–569. doi: 10.1136/ard.47.7.563. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Will R., Palmer R., Bhalla A. K., Ring F., Calin A. Osteoporosis in early ankylosing spondylitis: a primary pathological event? Lancet. 1989 Dec 23;2(8678-8679):1483–1485. doi: 10.1016/s0140-6736(89)92932-2. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES