The Increasing Level of DKK-1 as a New Bone Formation Factor in Patients with Early Spondyloarthritis

Abstract

The role of dickkopf-related protein 1 (DKK-1) in radiographic development may become a robust marker for early spondyloarthritis (SpA) diagnosis. This study aimed at determining the serum DKK-1 profile in patients with SpA and investigating its relationship with SpA progression. Supported by analyzing the BMD data which aims to affirm the potential of DKK-1 as a biomarker for early diagnosis of SpA, this research may become the early study to produce a robust tool to diminish the fatal impacts in SpA. This cross-sectional study included patients with SpA using ASAS 2010 criteria from Dr. Soetomo General Hospital, Indonesia. Collected data included patients’ general characteristics, disease duration, disease activity using ASDAS-CRP and ASDAS-ESR, serum DKK-1 levels, and BMD. The patients were classified as early SpA if the disease duration was ≤5 years and established SpA if the disease duration was >5 years, while the low BMD was indicated by Z score ≤ −2.00. The correlation was tested using the Spearman or Pearson test. The differences in patients’ characteristics among early and established SpA and also between low and normal BMD were tested using the unpaired T-test or the Mann–Whitney test. The serum DKK-1 levels in early SpA (7365 ± 2067 pg/dL) were significantly higher than those in established SpA (5360 ± 1054 pg/dL). Serum DKK-1 levels were also associated with disease duration (r = −0.370, p = 0.040 ) and BMD at the total hip (r = 0.467, p = 0.028 ). The differences in all patients’ clinical parameters were not found between patients with low BMD at any site and patients with normal BMD unless in the BMI ( p = 0.019 ). Our findings found DKK-1 as a potential diagnostic marker for early SpA. Early diagnosis may lead to rapid treatment to delay disease progression and prevent future impairment.

Clinical and Demographic Profiling of Patients with Spondyloarthritis and Its Association with Disease Activity in a Tertiary Hospital in Surabaya, Indonesia

“…As shown in our findings, we identified 38 SpA patients, with the majority were female. In our prior research, we also documented a prevalence of females in patients with SpA, where the male-to-female ratio stood at 15:16 (Yuliasih et al, 2023). The SpA typically initiates during the second or third decade of life, onset after the age of 50 reported to be rare.…”

“…Monti et al (2017) stressed the importance of ASDAS-CRP as a strict disease activity index for "treat to target" approaches to prevent inactive disease with fibromyalgia-like symptoms. Yuliasih et al (2022Yuliasih et al ( , 2023 found a correlation between ASDAS-CRP levels and IL-17. Zhang et al (2022) suggested that ASDAS based on ESR might be superior, and Ramiro et al (2013) demonstrated ASDAS-CRP's better prediction of radiological changes than BASDAI.…”

Higher Synovial Immunohistochemistry Reactivity of IL-17A, Dkk1, and TGF-β1 in Patients with Early Psoriatic Arthritis and Rheumatoid Arthritis Could Predict the Use of Biologics

“…Abnormal elevation of Dkk1 in patients with PsA and RA is thought to be involved in the process of structural radiographic alterations and the development of bone erosion [55,56]. In addition, Dkk1 has been identified as a possible diagnostic marker for early PsA, and its levels are higher in early PsA compared to established PsA [57].…”