To investigate whether calprotectin (S100A8/A9 or MRP8/14), an inflammatory complex released by monocytes, could indicate residual subclinical inflammation in rheumatoid arthritis (RA) patients who are in stable remission on disease-modifying anti-rheumatic drugs (DMARDs) and serve as a marker for disease flare after DMARD tapering. We used data from two trials. Patients from the IMPROVED study had early (< 2 years) RA, and when they achieved disease activity score remission (DAS44 < 1.6), they stopped methotrexate to attempt drug-free remission. Patients from the RETRO study had established RA in stable remission (DAS28 < 2.6) and either tapered by 50% or stopped (biological or conventional) DMARDs. Circulating calprotectin at the tapering time point was determined by ELISA, and its predictive value for flare (loss of remission) within 12 months of DMARD tapering/stopping was determined. In both IMPROVED (n = 104) and RETRO (n = 57), patients that flared within 12 months had higher calprotectin at the moment of DMARD tapering/stopping. Twofold higher calprotectin at the moment of DMARD tapering/stopping was associated with an increased risk (odds ratio) of flare of 1.07 (95% CI 0.98–1.18, p = 0.14) in the IMPROVED and 3.62 (95% CI 1.76–7.46, p < 0.001) in the RETRO. Correcting for clinical predictors of flare (DAS at study inclusion, anti-CCP2 positivity, gender) did not change these estimates. The area under the receiver operating curve of calprotectin levels for predicting flare within 12 months was 0.63 (95% CIs 0.51–0.76) in the IMPROVED study and 0.80 (95% CIs 0.69 to 0.92) in the RETRO study. Circulating calprotectin levels in RA patients in remission on DMARDs are higher in patients that will flare upon DMARD tapering/stopping. Since the differences between the cohorts precluded definitive conclusions, more research is needed to determine whether calprotectin has prognostic value in predicting flare after attempting drug tapering in RA. IMPROVED, ISRCTN11916566. RETRO, 2009-015740-42.

中文翻译：

---

类风湿性关节炎患者在逐渐减少抗风湿药后12个月内复发，循环钙卫蛋白（S100A8 / A9）更高。

为了研究钙卫蛋白（S100A8 / A9或MRP8 / 14）（一种由单核细胞释放的炎症复合物）是否可能表明类风湿关节炎（RA）患者的残留亚临床炎症，这些患者在疾病缓解性抗风湿药（DMARDs）和DMARD逐渐变细后，可作为疾病爆发的标志。我们使用了两次试验的数据。来自IMPROVED研究的患者患有早期（<2年）RA，并且当他们实现疾病活动评分缓解（DAS44 <1.6）时，他们停止了甲氨蝶呤以尝试无药物缓解。来自RETRO研究的患者已经建立了稳定缓解的RA（DAS28 <2.6），并且逐渐减少了50％或停止使用（生物或常规）DMARD。通过ELISA测定渐缩时间点的循环钙卫蛋白，并确定其在DMARD渐缩/停止后12个月内的耀斑（缓解损失）的预测值。在改良患者（n = 104）和逆转患者（n = 57）中，在DMARD逐渐变细/停止时，在12个月内发作的患者钙卫蛋白的含量较高。在DMARD逐渐变细/停止时，钙卫蛋白的含量增加两倍，与改良区火炬风险增加1.07（95％CI 0.98-1.18，p = 0.14）和3.62（95％CI 1.76-7.46， p <0.001）。校正耀斑的临床预测指标（研究入选时的DAS，抗CCP2阳性，性别）不会改变这些估计值。钙卫蛋白水平在接收者工作曲线下用于预测12个月内发作的面积在IMPROVED研究中为0.63（95％CIs 0.51-0.76），而在RETRO研究中为0.80（95％CIs 0.69至0.92）。DMARD逐渐减量/停药后会发作的RA患者中，DMARD缓解后的循环钙卫蛋白水平较高。由于队列之间的差异排除了明确的结论，因此需要更多的研究来确定钙卫蛋白在尝试在RA中减少药物剂量后是否具有预测火炬的预后价值。改进，ISRCTN11916566。复古，2009-015740-42。