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Non-Hepatic Alkaline Phosphatase, hs-CRP and Progression of Vertebral Fracture in Patients with Rheumatoid Arthritis: A Population-Based Longitudinal Study

1
Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
2
School of Dentistry, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 106, Taiwan
3
Department of Orthopedics, En Chu Kong Hospital, New Taipei City 237, Taiwan
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Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu 300, Taiwan
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Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei 106, Taiwan
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Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei 106, Taiwan
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Department of Community Medicine, En Chu Kong Hospital, New Taipei City 237, Taiwan
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Department of Nursing, Yuanpei University of Medical Technology, Hsinchu 300, Taiwan
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Department of Civil Engineering, National Taiwan University, Taipei 106, Taiwan
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School of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan
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Division of Rheumatology, Department of Internal Medicine, En Chu Kong Hospital, New Taipei City 237, Taiwan
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Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei 112, Taiwan
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Graduate Institution of Biomedical and Pharmaceutical Science, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan
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Division of Nephrology, Department of Internal Medicine, En Chu Kong Hospital, New Taipei City 237, Taiwan
15
Renal Care Joint Foundation, New Taipei City 220, Taiwan
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Program in Nutrition and Food Sciences, College of Human Ecology, Fu Jen Catholic University, New Taipei City 242, Taiwan
*
Authors to whom correspondence should be addressed.
These authors contributed equally to this work.
Received: 25 October 2018 / Revised: 8 November 2018 / Accepted: 10 November 2018 / Published: 13 November 2018
(This article belongs to the Section Orthopedics)
Background: Interactions and early warning effects of non-hepatic alkaline phosphatase (NHALP) and high-sensitivity C-reactive protein (hs-CRP) on the progression of vertebral fractures (VFs) in patients with rheumatoid arthritis (RA) remain unclear. We aim to explore whether serum concentrations of NHALP and hs-CRP could serve as a promising dual biomarker for prognostic assessment of VF progression. Methods: Unadjusted and adjusted hazard ratios (aHRs) of VF progression were calculated for different categories of serum NHALP and hs-CRP using the Cox regression model in RA patients. The modification effect between serum NHALP and hs-CRP on VF progression was determined using an interaction product term. Results: During 4489 person-years of follow-up, higher NHALP (>125 U/L) and hs-CRP (>3.0 mg/L) were robustly associated with incremental risks of VF progression in RA patients (aHR: 2.2 (95% confidence intervals (CIs): 1.2–3.9) and 2.0 (95% CI: 1.3–3.3) compared to the lowest HR category, respectively). The interaction between NHALP and hs-CRP on VF progression was statistically significant (p < 0.05). In the stratified analysis, patients with combined highest NHALP and hs-CRP had the greatest risk of VF progression (aHR: 4.9 (95% CI: 2.5–9.6)) compared to the lowest HR group (NHALP < 90 U/L and hs-CRP < 1 mg/L). Conclusions: In light of underdiagnoses of VFs and misleading diagnosis by single test, NHALP and hs-CRP could serve as compensatory biomarkers to predict subclinical VF progression in RA patients. View Full-Text
Keywords: alkaline phosphatase; C-reactive protein; rheumatoid arthritis; vertebral fractures alkaline phosphatase; C-reactive protein; rheumatoid arthritis; vertebral fractures
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MDPI and ACS Style

Yeh, J.-C.; Wu, C.-C.; Choy, C.-S.; Chang, S.-W.; Liou, J.-C.; Chen, K.-S.; Tung, T.-H.; Lin, W.-N.; Hsieh, C.-Y.; Ho, C.-T.; Wang, T.-M.; Chang, J.-F. Non-Hepatic Alkaline Phosphatase, hs-CRP and Progression of Vertebral Fracture in Patients with Rheumatoid Arthritis: A Population-Based Longitudinal Study. J. Clin. Med. 2018, 7, 439. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm7110439

AMA Style

Yeh J-C, Wu C-C, Choy C-S, Chang S-W, Liou J-C, Chen K-S, Tung T-H, Lin W-N, Hsieh C-Y, Ho C-T, Wang T-M, Chang J-F. Non-Hepatic Alkaline Phosphatase, hs-CRP and Progression of Vertebral Fracture in Patients with Rheumatoid Arthritis: A Population-Based Longitudinal Study. Journal of Clinical Medicine. 2018; 7(11):439. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm7110439

Chicago/Turabian Style

Yeh, Jih-Chen, Chang-Chin Wu, Cheuk-Sing Choy, Shu-Wei Chang, Jian-Chiun Liou, Kuo-Shu Chen, Tao-Hsin Tung, Wei-Ning Lin, Chih-Yu Hsieh, Chun-Ta Ho, Ting-Ming Wang, and Jia-Feng Chang. 2018. "Non-Hepatic Alkaline Phosphatase, hs-CRP and Progression of Vertebral Fracture in Patients with Rheumatoid Arthritis: A Population-Based Longitudinal Study" Journal of Clinical Medicine 7, no. 11: 439. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm7110439

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