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Adrenomedullin Levels May Indicate Increased Disease Activity in Rheumatoid Arthritis

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Adrenomedullin Levels May Indicate Increased Disease Activity in Rheumatoid

Arthritis

A DGReview of : " Increased plasma and joint tissue adrenomedullin

concentrations in patients with rheumatoid arthritis compared to those with

osteoarthritis "

Journal of Rheumatology

01/30/2004

By Deanna M Green, PhD

Adrenomedullin levels are significantly higher in patients with rheumatoid

arthritis (RA) than in patients with osteoarthritis or in healthy controls,

according to results from plasma, synovium, and joint fluid samples.

Measurements of adrenomedullin levels may be useful in assessing disease

activity. Increased levels of plasma adrenomedullin have been reported in

some collagenous and rheumatic disorders and may function in the regulation

of inflammation. The role of adrenomedullin in RA, however, has not been

investigated.

Etsuo Chosa, MD, PhD, and colleagues at the Miyazaki Medical College, Japan,

evaluated plasma adrenomedullin levels in patients with RA as compared to

healthy controls and patients with OA.

The study included 26 women with stage 4/class 2 RA, 10 healthy women, and

10 women with stage 4 or 5 OA. Adrenomedullin levels were measured in whole

blood samples from all participants and in joint fluid, synovial tissue, and

cartilage acquired during total knee arthroplasty in 6 patients with RA and

6 with OA.

Total and mature adrenomedullin plasma levels in RA patients were about 1.7

times higher than in healthy controls and about 1.4 times higher than in OA

patients.

Specifically, total adrenomedullin plasma levels were 18.35 fmol/mL in

patients with RA, 12.88 fmol/mL in patients with OA, and 11.64 fmol/mL in

healthy controls (P < .01 for RA vs. healthy and OA samples).

Adrenomedullin levels were also significantly higher in the joint fluid and

synovial tissue of RA patients when compared to OA patients. Adrenomedullin

levels were highest in the synovial tissue, 156 fmol/g versus 51 fmol/g in

patients with OA (P < .01). However, similar levels of adrenomedullin were

seen in the articular cartilage.

Notably, both total and mature plasma adrenomedullin levels correlated

positively with plasma C-reactive protein levels (CRP). Since CRP levels

have been found to correlate with disease activity and response to therapy,

it could suggest that adrenomedullin levels may also correlate with disease

activity.

The authors conclude that " adrenomedullin probably plays a part in the

regulation of the inflammatory process of RA, and its plasma and/or joint

fluid levels could be used as an index of the degree of RA. "

J Rheumatol 2003 Dec;30:12:2553-6

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