Background Raised concentrations of soluble intercellular adhesion molecule-1 (ICAM-1) and E-selectin (E-sel) are believed to reflect processes of their up-regulation and endothelial cell (EC) activation by various inflammatory stimuli. Resulting enhancement of cell infiltration is a pre-recquisite of tissue damage.
Objectives To evaluate serum and synovial fluid (SF) concentrations of ICAM-1 and E-sel in patients with juvenile idiopathic arthritis (JIA) and in paediatric controls and to correlate them with clinical and laboratory variables.
Methods Total of 33 JIA patients (mean age 10 y) were evaluated: 18 with polyarthritis (JIApoly) disease course (mean active joint count 9) and 15 with oligoarthritis (JIAoligo). Paediatric age-matched control groups consisted of 11 Henoch-Schönlein purpura (HSP) and 10 febrile (FC) patients and 28 healthy children. Current medication, ESR, CRP and FBC were recorded. Soluble ICAM-1 and E-sel in serum and SF were measured by commercially available sandwich ELISA kits.
Results Significant negative correlation with age was observed for the whole group (ICAM-1: p < 0.01, E-sel: p < 0.001), E-sel correlated with leucocyte and thrombocyte counts (p < 0.01), both molecules with CRP (p < 0.05) and with each other (p < 0.01). For JIA group as a whole no correlation was found with disease duration or therapy used. JIAoligo did not differ from controls, in JIApoly levels of both molecules were higher than in healthy (p < 0.001 for ICAM-1, p < 0.06 for E-sel), but not febrile controls. Both molecules correlated with active joint count (p < 0.01). In 13 JIA patients (9 oligo, 4 polyarthritis) no correlation was found of SF ICAM-1 and E-sel concentrations with SF leucocyte counts. Although levels of ICAM-1 appeared to be higher in SF than in serum the difference was not significant.
Conclusion High concentrations of soluble ICAM-1 and E-sel in JIA patients with polyarthritis are reported here for the first time. Bloom1 and de Benedetti2 found increased ICAM-1 and E-sel levels only in systemic JIA. In our patients only 3 had systemic onset disease, none showed signs of vasculitis or infection. Our finding of correlation of both molecule levels with joint count supports the hypothesis of synovial EC origin of these molecules. It brings interesting insight in suspected disease pathogenesis in terms of endothelial activation, leucocyte migration and angiogenesis. ICAM-1 and E-sel could be a marker of aggressive disease, but their predictive value needs to be further studied.
Bloom BJ, Miller LC, Tucker LB, et al. Soluble adhesion molecules in juvenile rheumatoid arthritis. J Rheumatol. 1999;26:2044–8
De Benedetti F, Vivarelli M, Pignatti P, et al. Circulating levels of soluble E-selectin, P-selectin and intercellular adhesion molecule-1 in patients with juvenile idiopathic arthritis. J Rheumatol. 2000;27:2246–50
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