Evaluation of the relationship of plasma netrin-1 level with disease activity and other clinical and laboratory parameters in patients with axial spondyloarthritis

Objective: It has been shown that the netrin-1 molecule increases in inflammatory diseases and is associated with disease activity. Early diagnosis and evaluation of disease activity in patients with axial spondyloarthritis (axial SpA) are important for determining the treatment. Plasma Netrin-1 level is thought to be a biomarker that can be used for diagnosis and evaluation of disease activity in patients with axial SpA. Therefore, our study aimed to evaluate plasma Netrin-1 levels and the relationship between Netrin-1 levels and disease activity parameters in patients with axial SpA. Materials and Methods: 60 volunteer patients with axial SpA between the ages of 18-65 who applied to Ankara Yıldırım Beyazıt University Faculty of Medicine - Ankara City Hospital Rheumatology outpatient clinic and 56 healthy volunteers who applied to Ankara Yıldırım Beyazıt University Faculty of Medicine-Ankara City Hospital Internal Medicine outpatient clinic were included in this study. Patients with systemic disease other than axial SpA, regular medication use other than axial SpA treatment and pregnant patients were excluded from the study. Rheumatology outpatient epicrisis, re-evaluation notes, anamnesis and examination information obtained by interviewing the patients and data were examined. Demographic information (age, gender) of the patient and control groups; Country of origin, family history, smoking, additional diseases, diagnosis year, treatments, laboratory values (HLA-B27, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), sacroiliac (SI) X-ray, SI MR), clinical findings ( duration of morning stiffness, peripheral joint involvement, achilles tendinitis/plantar fasciitis, costochondritis, uveitis, psoriasis), disease activity scores (VAS, BASDAI, ASDAS CRP) were determined and recorded. In addition to the parameters routinely checked in the patients, Netrin-1 level was measured with the Enzyme Linked Immuno Sorbent Assay (ELISA) method. Results: 60 axial SpA patients and 56 healthy controls were included in our study. The mean Netrin-1 level of the axial SpA group was 74,436 (34.5-237.18) and the mean Netrin-1 level of the control group was 61,904 (35.85-175.33). There was no statistically significant difference between the axial SpA group and the control group when the axial SpA group was divided into ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (Nr axSpA) compared to each other and the control group. There was a weak positive correlation between netrin-1 level and the duration of morning stiffness, and a moderately strong positive correlation between VAS, BASDAI and ASDAS CRP scores, but no significant correlation was found between SI radiograph stage, CRP and ESR levels. When axial SpA patients were divided into two groups according to family history, HLA-B27 positivity, peripheral joint involvement, presence of achilles tendinitis/plantar fasciitis, presence of costochondritis, history of uveitis, coexistence of psoriasis and smoking, no statistically significant difference was found between them in terms of Netrin-1 levels. According to the treatments they used (NSAID, salazopyrine, biologic agent), there was no statistically significant difference in terms of Netrin-1 levels between the groups. Conclusion: Obtaining a positive correlation between the Netrin-1 molecule which is accepted as an inflammation marker and VAS, BASDAI, ASDAS CRP scores which are the scoring systems used to evaluate disease activity and the duration of morning stiffness, together with more comprehensive supportive studies to be carried out in this field, the use of Netrin-1 molecule suggested that it may enter clinical use as a new indicator of disease activity in patients with axial SpA.