Background The B cell chemoattractant CXCL13 is a promising biomarker in rheumatoid arthritis (RA), with a plausible role in supporting diagnosis, monitoring disease activity and as a prognostic value. It is a key chemokine driving the formation of lymphoid follicles within the inflamed synovium. The objective of this systematic review was to evaluate the role of CXCL13 as a viable biomarker in RA. Methods We conducted a systematic literature review of all published cohort and randomised controlled trials evaluating the role of CXCL13 in RA. The primary outcomes were; i) CXCL13 levels in RA patients compared to healthy controls, ii) the correlation between CXCL13 and markers of disease activity, and iii) the association between CXCL13 and treatment response. Results The search produced 278 articles, of which 31 met the inclusion criteria. Of the 12 studies evaluating CXCL13 expression in early or established RA, all reported higher levels than that seen in healthy controls. Twelve of sixteen studies reported a weakly positive correlation between CXCL13 and markers of disease activity including DAS28 and swollen joint count, with rho values between 0.20–0.67. In 2 studies, CXCL13 levels correlated with ultrasonographic evidence of synovitis. Eighteen studies assessed CXCL13 in response to therapeutic intervention. The majority signified a fall in levels in response to treatment including biologics and Janus kinase (JAK) inhibition. In some, this reduction was only seen in treatment responders. High CXCL13 levels predicted failure to achieve disease remission with csDMARDs. The evidence for treatment prediction with biologics was conflicting. Conclusion Despite evidence to suggest a role in diagnosing RA and in detecting synovitis, the heterogeneity of studies included in this review limit our ability to draw robust conclusions. At present there are inadequate results to justify the routine use of CXCL13 as a biomarker in RA routine clinical practice.

Supplemental Digital Content is Available in the Text.

No abstract

BackgroundDysregulation of the immune system represents an important vulnerability factor for schizophrenia. A rise in peripheral inflammatory markers has previously been demonstrated in psychosis; however, its significance remains uncertain. Characterising this relationship aids our understanding of the role of immunological factors in psychosis, as well as potentially identifying candidate biomarkers to guide diagnosis, treatment and prognosis. Whilst specialized inflammatory marker assays have been found to be associated with outcome and treatment, these tests are not typically available in clinical practice. We sought to establish whether routine inflammatory markers are associated with clinical characteristics and outcomes in patients with schizophrenia and related disorders.MethodsA multi-site cohort study of patients admitted to an acute psychiatric ward between January 2013 and December 2016 within a large Mental Health Trust was undertaken. Cases were identified from an electronic database containing full clinical records. Inclusion criteria were patients aged 18 and 65 years with a discharge diagnosis of schizophrenia, or related disorder and a routine blood test within 3 days of admission. Exclusion criteria were diagnoses of drug-induced psychosis, organic brain disorder, or admission during the perinatal period. Pro-inflammatory (white blood cell total and differential count, C-reactive protein) and anti-inflammatory markers (albumin) recorded during the admission were extracted. Clinical characteristics were based upon the Health of the Nation Outcome Scale, a 12-item clinician rated tool contemporaneously rated at admission and discharge.ResultsA total of 968 patients met the inclusion criteria. 309 patients were female and mean age was 38 years. The most frequent ethnicities were White, Black African, Black Other and Black Caribbean and the commonest diagnoses were schizophrenia, unspecified non-organic psychosis and schizoaffective disorder. Mean interval from admission to admission blood test was 0.8 days.Patients with affective psychosis had a significantly higher white cell count, monocyte count and lymphocyte count than patients with non-affective psychosis on admission. Furthermore, among patients with affective psychosis, a partial correlation controlling for age, body mass index, blood pressure, physical health and smoking status found a significant association between symptom severity and monocyte count. There was a highly significant association between both neutrophil count and white cell count with hallucinatory symptoms. There was also a highly significant positive association between C-reactive protein and self-injurious behaviour, replicating recently published findings in smaller samples. There was a significant reduction in overall psychiatric symptoms over the course of admission, which was significantly associated with admission monocyte count. A partial correlation found white cell count and neutrophil count at admission were associated with reductions in hallucinatory ...

ObjectiveThere is interest in identifying reliable prognostic biomarkers in schizophrenia and related disorders. Serum inflammatory markers, such as white cell count and C-reactive protein (CRP), have been shown to be elevated during psychotic episodes; however, their pathogenic role is uncertain. There is limited data relating to their variability in clinical practice and relationship to clinical outcome. We have sought to investigate whether routine clinical case records contain the necessary data to further understand the relationship between serum inflammatory markers and prognosis.MethodThis is a retrospective case note review of patients admitted to an inner city female acute psychiatry ward. Cases were identified by reviewing electronic ward round records. Patients included had a diagnosis of non-affective, non-drug induced psychosis (schizophrenia, acute and transient psychotic disorder, persistent delusional disorder, schizotypal disorder and nonorganic psychosis) and had received a routine admission blood test. Exclusion criteria included pregnancy, significant recreational drug use prior to admission, clinical evidence of infection or history of inflammatory or haematological disease.ResultsA total of 20 patients met the inclusion criteria between April 2015 and October 2016. Mean age was 43 years (SD=15) and the most common ethnicities were White British (23%), Mixed Ethnicity (23%), and Caribbean (23%). The majority of cases were detained under the Mental Health Act (68%) and had previously been treated with antipsychotic medication (94%). Mean admission duration was 38 days (SD=30) and average time from admission to routine admission blood test was 4 days (SD=3 days). Admission duration was moderately positively correlated with white cell count (r=0.41, n=20, p=0.07), platelet count (r=0.40, n=20, p=0.08) and albumin (r=0.42, n=20, p=0.07). Admission duration was weakly correlated with neutrophil count (r=0.27, n=20, p=0.24) and CRP (r=−0.22, n=20, p=0.35). When patients split according to those above and below the median admission length, patients with longer admissions had significantly higher platelet count (p<0.05) only.ConclusionThis small retrospective review suggests that in routine clinical case practice information is collected which could be used to explore the role of inflammatory markers as prognostic biomarkers in patients with schizophrenia and related disorders. Despite our extremely small sample we have found a positive correlation between platelet count and admission length. However this needs to be considered in the presence of multiple confounders. Use of electronic patient databases may be helpful in extending the sample to formally establish any prognostic relationships.