Non-Hepatic Alkaline Phosphatase, hs-CRP and Progression of Vertebral Fracture in Patients with Rheumatoid Arthritis: A Population-Based Longitudinal Study

Jih-Chen Yeh; Chang-Chin Wu; Cheuk-Sing Choy; Shu-Wei Chang; Jian-Chiun Liou; Kuo-Shu Chen; Tao-Hsin Tung; Wei-Ning Lin; Chih-Yu Hsieh; Chun-Ta Ho; Ting-Ming Wang; Jia-Feng Chang

doi:10.3390/jcm7110439

Non-Hepatic Alkaline Phosphatase, hs-CRP and Progression of Vertebral Fracture in Patients with Rheumatoid Arthritis: A Population-Based Longitudinal Study

Jih-Chen Yeh, Chang-Chin Wu, Cheuk-Sing Choy, Shu-Wei Chang, Jian-Chiun Liou, Kuo-Shu Chen, Tao-Hsin Tung, Wei-Ning Lin, Chih-Yu Hsieh, Chun-Ta Ho, Ting-Ming Wang, Jia-Feng Chang

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Abstract

BACKGROUND: Interactions and early warning effects of non-hepatic alkaline phosphatase (NHALP) and high-sensitivity C-reactive protein (hs-CRP) on the progression of vertebral fractures (VFs) in patients with rheumatoid arthritis (RA) remain unclear. We aim to explore whether serum concentrations of NHALP and hs-CRP could serve as a promising dual biomarker for prognostic assessment of VF progression.

METHODS: Unadjusted and adjusted hazard ratios (aHRs) of VF progression were calculated for different categories of serum NHALP and hs-CRP using the Cox regression model in RA patients. The modification effect between serum NHALP and hs-CRP on VF progression was determined using an interaction product term.

RESULTS: During 4489 person-years of follow-up, higher NHALP (>125 U/L) and hs-CRP (>3.0 mg/L) were robustly associated with incremental risks of VF progression in RA patients (aHR: 2.2 (95% confidence intervals (CIs): 1.2⁻3.9) and 2.0 (95% CI: 1.3⁻3.3) compared to the lowest HR category, respectively). The interaction between NHALP and hs-CRP on VF progression was statistically significant (p < 0.05). In the stratified analysis, patients with combined highest NHALP and hs-CRP had the greatest risk of VF progression (aHR: 4.9 (95% CI: 2.5⁻9.6)) compared to the lowest HR group (NHALP < 90 U/L and hs-CRP < 1 mg/L).

CONCLUSIONS: In light of underdiagnoses of VFs and misleading diagnosis by single test, NHALP and hs-CRP could serve as compensatory biomarkers to predict subclinical VF progression in RA patients.

Original language	English
Journal	Journal of Clinical Medicine
Volume	7
Issue number	11
DOIs	https://doi.org/10.3390/jcm7110439
Publication status	Published - Nov 13 2018

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10.3390/jcm7110439

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Yeh, J.-C., Wu, C.-C., Choy, C.-S., Chang, S.-W., Liou, J.-C., Chen, K.-S., Tung, T.-H., Lin, W.-N., Hsieh, C.-Y., Ho, C.-T., Wang, T.-M., & Chang, J.-F. (2018). Non-Hepatic Alkaline Phosphatase, hs-CRP and Progression of Vertebral Fracture in Patients with Rheumatoid Arthritis: A Population-Based Longitudinal Study. Journal of Clinical Medicine, 7(11). https://doi.org/10.3390/jcm7110439

Yeh, J-C, Wu, C-C, Choy, C-S, Chang, S-W, Liou, J-C, Chen, K-S, Tung, T-H, Lin, W-N, Hsieh, C-Y, Ho, C-T, Wang, T-M & Chang, J-F 2018, 'Non-Hepatic Alkaline Phosphatase, hs-CRP and Progression of Vertebral Fracture in Patients with Rheumatoid Arthritis: A Population-Based Longitudinal Study', Journal of Clinical Medicine, vol. 7, no. 11. https://doi.org/10.3390/jcm7110439

@article{664753b9d1a2472eb7afb7ee5e293a83,

title = "Non-Hepatic Alkaline Phosphatase, hs-CRP and Progression of Vertebral Fracture in Patients with Rheumatoid Arthritis: A Population-Based Longitudinal Study",

abstract = "BACKGROUND: Interactions and early warning effects of non-hepatic alkaline phosphatase (NHALP) and high-sensitivity C-reactive protein (hs-CRP) on the progression of vertebral fractures (VFs) in patients with rheumatoid arthritis (RA) remain unclear. We aim to explore whether serum concentrations of NHALP and hs-CRP could serve as a promising dual biomarker for prognostic assessment of VF progression.METHODS: Unadjusted and adjusted hazard ratios (aHRs) of VF progression were calculated for different categories of serum NHALP and hs-CRP using the Cox regression model in RA patients. The modification effect between serum NHALP and hs-CRP on VF progression was determined using an interaction product term.RESULTS: During 4489 person-years of follow-up, higher NHALP (>125 U/L) and hs-CRP (>3.0 mg/L) were robustly associated with incremental risks of VF progression in RA patients (aHR: 2.2 (95% confidence intervals (CIs): 1.2⁻3.9) and 2.0 (95% CI: 1.3⁻3.3) compared to the lowest HR category, respectively). The interaction between NHALP and hs-CRP on VF progression was statistically significant (p < 0.05). In the stratified analysis, patients with combined highest NHALP and hs-CRP had the greatest risk of VF progression (aHR: 4.9 (95% CI: 2.5⁻9.6)) compared to the lowest HR group (NHALP < 90 U/L and hs-CRP < 1 mg/L).CONCLUSIONS: In light of underdiagnoses of VFs and misleading diagnosis by single test, NHALP and hs-CRP could serve as compensatory biomarkers to predict subclinical VF progression in RA patients.",

keywords = "alkaline phosphatase, C-reactive protein, rheumatoid arthritis, vertebral fractures",

author = "Jih-Chen Yeh and Chang-Chin Wu and Cheuk-Sing Choy and Shu-Wei Chang and Jian-Chiun Liou and Kuo-Shu Chen and Tao-Hsin Tung and Wei-Ning Lin and Chih-Yu Hsieh and Chun-Ta Ho and Ting-Ming Wang and Jia-Feng Chang",

year = "2018",

month = nov,

day = "13",

doi = "10.3390/jcm7110439",

language = "English",

volume = "7",

journal = "Journal of Clinical Medicine",

issn = "2077-0383",

publisher = "MDPI AG",

number = "11",

}

TY - JOUR

T1 - Non-Hepatic Alkaline Phosphatase, hs-CRP and Progression of Vertebral Fracture in Patients with Rheumatoid Arthritis

T2 - A Population-Based Longitudinal Study

AU - Yeh, Jih-Chen

AU - Wu, Chang-Chin

AU - Choy, Cheuk-Sing

AU - Chang, Shu-Wei

AU - Liou, Jian-Chiun

AU - Chen, Kuo-Shu

AU - Tung, Tao-Hsin

AU - Lin, Wei-Ning

AU - Hsieh, Chih-Yu

AU - Ho, Chun-Ta

AU - Wang, Ting-Ming

AU - Chang, Jia-Feng

PY - 2018/11/13

Y1 - 2018/11/13

N2 - BACKGROUND: Interactions and early warning effects of non-hepatic alkaline phosphatase (NHALP) and high-sensitivity C-reactive protein (hs-CRP) on the progression of vertebral fractures (VFs) in patients with rheumatoid arthritis (RA) remain unclear. We aim to explore whether serum concentrations of NHALP and hs-CRP could serve as a promising dual biomarker for prognostic assessment of VF progression.METHODS: Unadjusted and adjusted hazard ratios (aHRs) of VF progression were calculated for different categories of serum NHALP and hs-CRP using the Cox regression model in RA patients. The modification effect between serum NHALP and hs-CRP on VF progression was determined using an interaction product term.RESULTS: During 4489 person-years of follow-up, higher NHALP (>125 U/L) and hs-CRP (>3.0 mg/L) were robustly associated with incremental risks of VF progression in RA patients (aHR: 2.2 (95% confidence intervals (CIs): 1.2⁻3.9) and 2.0 (95% CI: 1.3⁻3.3) compared to the lowest HR category, respectively). The interaction between NHALP and hs-CRP on VF progression was statistically significant (p < 0.05). In the stratified analysis, patients with combined highest NHALP and hs-CRP had the greatest risk of VF progression (aHR: 4.9 (95% CI: 2.5⁻9.6)) compared to the lowest HR group (NHALP < 90 U/L and hs-CRP < 1 mg/L).CONCLUSIONS: In light of underdiagnoses of VFs and misleading diagnosis by single test, NHALP and hs-CRP could serve as compensatory biomarkers to predict subclinical VF progression in RA patients.

AB - BACKGROUND: Interactions and early warning effects of non-hepatic alkaline phosphatase (NHALP) and high-sensitivity C-reactive protein (hs-CRP) on the progression of vertebral fractures (VFs) in patients with rheumatoid arthritis (RA) remain unclear. We aim to explore whether serum concentrations of NHALP and hs-CRP could serve as a promising dual biomarker for prognostic assessment of VF progression.METHODS: Unadjusted and adjusted hazard ratios (aHRs) of VF progression were calculated for different categories of serum NHALP and hs-CRP using the Cox regression model in RA patients. The modification effect between serum NHALP and hs-CRP on VF progression was determined using an interaction product term.RESULTS: During 4489 person-years of follow-up, higher NHALP (>125 U/L) and hs-CRP (>3.0 mg/L) were robustly associated with incremental risks of VF progression in RA patients (aHR: 2.2 (95% confidence intervals (CIs): 1.2⁻3.9) and 2.0 (95% CI: 1.3⁻3.3) compared to the lowest HR category, respectively). The interaction between NHALP and hs-CRP on VF progression was statistically significant (p < 0.05). In the stratified analysis, patients with combined highest NHALP and hs-CRP had the greatest risk of VF progression (aHR: 4.9 (95% CI: 2.5⁻9.6)) compared to the lowest HR group (NHALP < 90 U/L and hs-CRP < 1 mg/L).CONCLUSIONS: In light of underdiagnoses of VFs and misleading diagnosis by single test, NHALP and hs-CRP could serve as compensatory biomarkers to predict subclinical VF progression in RA patients.

KW - alkaline phosphatase

KW - C-reactive protein

KW - rheumatoid arthritis

KW - vertebral fractures

U2 - 10.3390/jcm7110439

DO - 10.3390/jcm7110439

M3 - Article

C2 - 30428612

SN - 2077-0383

VL - 7

JO - Journal of Clinical Medicine

JF - Journal of Clinical Medicine

IS - 11

ER -

Non-Hepatic Alkaline Phosphatase, hs-CRP and Progression of Vertebral Fracture in Patients with Rheumatoid Arthritis: A Population-Based Longitudinal Study

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