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Answer to “comment on fecal calprotectin as a biomarker of microscopic bowel inflammation in patients with spondyloarthritis”
2022; Wiley; Volume: 26; Issue: 1 Linguagem: Inglês
10.1111/1756-185x.14458
ISSN1756-185X
AutoresJúlia Faria Campos, Gustavo Gomes Resende, Maria de Lourdes Abreu Ferrari,
Tópico(s)Pancreatitis Pathology and Treatment
ResumoInternational Journal of Rheumatic DiseasesVolume 26, Issue 1 p. 175-176 COMMENTFree Access Answer to "comment on fecal calprotectin as a biomarker of microscopic bowel inflammation in patients with spondyloarthritis" Júlia Faria Campos, Corresponding Author Júlia Faria Campos j.fariacampos@gmail.com orcid.org/0000-0001-7983-534X Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal, de Minas Gerais, Belo Horizonte, Brazil Correspondence Júlia Faria Campos, Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Santa Efigênia, Belo Horizonte, Minas Gerais, 20301230-100 Brazil. Email: j.fariacampos@gmail.comSearch for more papers by this authorGustavo Gomes Resende, Gustavo Gomes Resende Departamento de Reumatologia, Hospital das Clínicas, Universidade Federal de, Minas Gerais, Belo Horizonte, BrazilSearch for more papers by this authorMaria de Lourdes Abreu Ferrari, Maria de Lourdes Abreu Ferrari Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal, de Minas Gerais, Belo Horizonte, BrazilSearch for more papers by this author Júlia Faria Campos, Corresponding Author Júlia Faria Campos j.fariacampos@gmail.com orcid.org/0000-0001-7983-534X Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal, de Minas Gerais, Belo Horizonte, Brazil Correspondence Júlia Faria Campos, Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Santa Efigênia, Belo Horizonte, Minas Gerais, 20301230-100 Brazil. Email: j.fariacampos@gmail.comSearch for more papers by this authorGustavo Gomes Resende, Gustavo Gomes Resende Departamento de Reumatologia, Hospital das Clínicas, Universidade Federal de, Minas Gerais, Belo Horizonte, BrazilSearch for more papers by this authorMaria de Lourdes Abreu Ferrari, Maria de Lourdes Abreu Ferrari Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal, de Minas Gerais, Belo Horizonte, BrazilSearch for more papers by this author First published: 14 October 2022 https://doi.org/10.1111/1756-185X.14458AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Dear Editor, We greatly appreciate the interest and the comments made by Allen Pai and colleagues about our article: "Fecal calprotectin as a biomarker of microscopic bowel inflammation in patients with spondyloarthritis". To clarify some issues raised by their letter, we would like to highlight some key points about our study's aims and its design. First, the study aimed to evaluate the utility of fecal calprotectin (fcal) in detecting endoscopic and microscopic bowel inflammation in patients with spondyloarthritis (SpA) but without a previous diagnosis of inflammatory bowel disease (IBD). The literature is extensive in demonstrating the important role of fcal in monitoring intestinal inflammation in patients with IBD.1 One of the main questions to be answered by our study was whether fcal could help in the judicious indication of colonoscopy in this subgroup of patients. It is relevant because SpA patients more frequently develop bowel inflammation than the general population2 and microscopic bowel inflammation appears to be a prognostic marker in SpA.3-6 We recruited 65 patients with SpA, in the pre-COVID-19 era in Brazil (the study was finished in August of 2019), without known chronic gastrointestinal disease, the majority of whom were oligosymptomatic. The decision to exclude patients with overt IBD and other chronic gastrointestinal diseases was to assess if fcal could be used to identify SpA patients at risk of bowel inflammation. Therefore, we did not find it necessary to look for extraintestinal manifestations related to IBD, such as acute pancreatitis. The use of indices to quantify the inflammatory activity of IBD was also not applicable. Second, we agree that fcal is a useful biomarker of bowel inflammation. However, it has limited specificity because its values can be influenced by various factors including age, smoking status, medication, pregnancy, SpA involvement subtypes, and disease activity. The literature shows that the interpretation of the fcal's cut-offs must consider the patient's clinical context, so different values are accepted for specific situations.7 In our research, we adjusted the factors that were most studied and well described as confounders of fcal levels in previous studies. Although overweight and obesity are pointed out as potential factors that could interfere with fcal levels, they are based on small studies, with conflicting results and limited statistical power.8-10 More studies are necessary to evaluate the real association between fcal and BMI. We did evaluate possible associations between gender, age, smoking status, SpA duration in years, and fcal levels, but none showed statistical relevance in our study. Third, we mentioned in our article that the sample size was a major limitation that may have impaired some evaluations and conclusions, especially those related to SpA treatment and fcal levels, and bowel inflammation. The fact that the research could not manifest a temporal relationship between bowel inflammation and fcal levels is an inherent limitation related to the cross-sectional design, not a bias of the study itself. Finally, we agree that implementing stratification of fcal levels could mitigate doubts about overestimated fcal levels in some samples. Our study group intends to increase the sample size and also follow up those patients who had high fcal levels in our research in order to evaluate outcomes related to SpA and bowel inflammation. REFERENCES 1Bertani L, Mumolo MG, Tapete G, et al. Fecal calprotectin: current and future perspectives for inflammatory bowel disease treatment. Eur J Gastroenterol Hepatol. 2020; 32(9): 1091- 1098. doi:10.1097/MEG.0000000000001731 2Klingberg E, Carlsten H, Hilme E, Hedberg M, Forsblad-d'Elia H. Calprotectin in ankylosing spondylitis frequently elevated in feces, but normal in serum. Scand J Gastroenterol. 2012; 47(4): 435- 444. doi:10.3109/00365521.2011.648953 3Van Praet L, Van den Bosch FE, Jacques P, et al. Microscopic gut inflammation in axial spondyloarthritis: a multiparametric predictive model. Ann Rheum Dis. 2013; 72(3): 414- 417. doi:10.1136/annrheumdis-2012-202135 4Van Praet L, Jans L, Carron P, et al. Degree of bone marrow oedema in sacroiliac joints of patients with axial spondyloarthritis is linked to gut inflammation and male sex: results from the GIANT cohort. Ann Rheum Dis. 2014; 73(6): 1186- 1189. doi:10.1136/annrheumdis-2013-203854 5Mielants H, Veys EM, De Vos M, et al. The evolution of spondyloarthropathies in relation to gut histology. i clinical aaspects. J Rheumatol. 1995; 22(12): 2266- 2272. 6Cypers H, Varkas G, Van Den Bosh F, Elewaut D. Microscopic bowel inflammation in Spondyloarthritis as a baseline predictor of anti-TNF response. Arthritis Rheumatol Suppl. 2015; 67(Suppl. 10). https://acrabstracts.org/abstract/microscopic-bowel-inflammation-in-spondyloarthritis-as-a-baseline-predictor-of-anti-tnf-response/ 7D'Amico F, Nancey S, Danese S, Peyrin-Biroulet L. A practical guide for Faecal calprotectin measurement: myths and realities. J Crohns Colitis. 2021; 15(1): 152- 161. doi:10.1093/ecco-jcc/jjaa093 8Mendall MA, Chan D, Patel R, Kumar D. Faecal calprotectin: factors affecting levels and its potential role as a surrogate marker for risk of development of Crohn's disease. BMC Gastroenterol. 2016; 16(1): 126. doi:10.1186/s12876-016-0535-z 9Kant P, Fazakerley R, Hull MA. Faecal calprotectin levels before and after weight loss in obese and overweight subjects. Int J Obes (Lond). 2013; 37(2): 317- 319. doi:10.1038/ijo.2012.38 10Poullis A, Foster R, Shetty A, Fagerhol MK, Mendall MA. Bowel inflammation as measured by fecal calprotectin: a link between lifestyle factors and colorectal cancer risk. Cancer Epidemiol Biomarkers Prev. 2004; 13(2): 279- 284. doi:10.1158/1055-9965.epi-03-0160 Volume26, Issue1January 2023Pages 175-176 ReferencesRelatedInformation
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