Angiopoietin-2/-1 ratios and MMP-3 levels as an early warning sign for the presence of giant cell arteritis in patients with polymyalgia rheumatica

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Yannick van Sleen, University of Groningen
  • ,
  • Philip Therkildsen
  • Berit Dalsgaard Nielsen
  • Kornelis S.M. van der Geest, University of Groningen
  • ,
  • Ib Hansen
  • Peter Heeringa, University of Groningen
  • ,
  • Marcel D. Posthumus, Martini Ziekenhuis
  • ,
  • Maria Sandovici, University of Groningen
  • ,
  • Erik J.M. Toonen, Hycult Biotech
  • ,
  • Jannik Zijlstra, University of Groningen
  • ,
  • Annemieke M.H. Boots, University of Groningen
  • ,
  • Ellen Margrethe Hauge
  • Elisabeth Brouwer, University of Groningen

BACKGROUND: Diagnosing patients with giant cell arteritis (GCA) remains difficult. Due to its non-specific symptoms, it is challenging to identify GCA in patients presenting with symptoms of polymyalgia rheumatica (PMR), which is a more common disease. Also, commonly used acute-phase markers CRP and ESR fail to discriminate GCA patients from PMR and (infectious) mimicry patients. Therefore, we investigated biomarkers reflecting vessel wall inflammation for their utility in the accurate diagnosis of GCA in two international cohorts. METHODS: Treatment-naïve GCA patients participated in the Aarhus AGP cohort (N = 52) and the Groningen GPS cohort (N = 48). The AGP and GPS biomarker levels and symptoms were compared to patients presenting phenotypically as isolated PMR, infectious mimicry controls and healthy controls (HCs). Serum/plasma levels of 12 biomarkers were measured by ELISA or Luminex. RESULTS: In both the AGP and the GPS cohort, we found that weight loss, elevated erythrocyte sedimentation rate (ESR) and higher angiopoietin-2/-1 ratios but lower matrix metalloproteinase (MMP)-3 levels identify concomitant GCA in PMR patients. In addition, we confirmed that elevated platelet counts are characteristic of GCA but not of GCA mimicry controls and that low MMP-3 and proteinase 3 (PR3) levels may help to discriminate GCA from infections. CONCLUSION: This study, performed in two independent international cohorts, consistently shows the potential of angiopoietin-2/-1 ratios and MMP-3 levels to identify GCA in patients presenting with PMR. These biomarkers may be used to select which PMR patients require further diagnostic workup. Platelet counts may be used to discriminate GCA from GCA look-alike patients.

Original languageEnglish
JournalArthritis Research & Therapy
Pages (from-to)65
Number of pages10
Publication statusPublished - Mar 2022

Bibliographical note

Publisher Copyright:
© 2022. The Author(s).

    Research areas

  • Angiopoietin-2, Giant cell arteritis, Look-alike patients, MMP-3, Platelets, Polymyalgia rheumatica

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