A new serum biochemical marker of synovium turnover predicts radiographic progression in patients with early arthritis.

To investigate whether serum Col 3-4, a new biochemical marker of synovial tissue turnover, was associated with progression of joint damage in patients with early arthritis. 788 early arthritis patients (<6-months symptoms, 82% diagnosis of RA, 18% undifferentiated arthritis) from the prospective ESPOIR study were investigated. Progression was defined as an increase of 1 or 5 unit(s) in radiographic van der Heijde modified Sharp score between baseline and 1 or 5 years, respectively. Associations between baseline Col 3-4 and progression were assessed by logistic regression. Each standard deviation increase of baseline Col 3-4 levels was associated with an increased 5-yr total damage progression with an odds-ratio (OR, 95 CI) of 1.51 (1.21-1.88), which remained significant when DAS28, C-reactive protein and anti-citrullinated protein antibodies positivity were included in the model [OR (95 CI): 1.34 (1.01-1.76)]. Further adjustment for bone erosion did not modify the association. Patients with both Col 3-4 in the highest quintile and bone erosion had a more than 2-fold higher risk of progression [OR (95 CI): 7.16 (2.31-22)] than patients with either high Col 3-4 [2.91 (1.79-4.73)] or bone erosion [2.36 (2.38-3.70)] alone. Similar associations were observed for prediction of 12 months progression. Increased serum Col 3-4 is associated with a higher risk of structural progression, independently of major risk factors. Col 3-4 may be useful in association with bone erosion to identify patients with early arthritis at higher risk.

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