Non-radiographic (nr-axSpA) and radiographic (AS) forms of axial spondyloarthritis (axSpA) share clinical features, but have different radiographic patterns. Radiographic progression is not associated with the current disease activity biomarkers. We investigated a matrix metalloproteinase mediated metabolite of C-reactive protein (CRPM) and two biomarkers of citrullinated vimentin (VICM and anti-MCV) as novel biomarkers of disease activity.

AxSpA patients (n=121 nr-axSpA and n=72 AS) were characterised by activity (AS disease activity score with CRP [ASDAS-CRP], Bath AS disease activity index [BASDAI] and functional index [BASFI]), radiographic scores and quality of life questionnaires. CRPM, VICM and anti-MCV levels were analysed by ELISA in serum. Asymptomatic controls (n=100) were used as reference. Multiple regression investigated association with disease activity and diagnostic potential.

CRPM and VICM levels were increased in AS compared to nr-axSpA (11.9nM vs. 10.2nM, p<0.001 and 4.92nM vs. 3.77nM, p=0.0025). Anti-MCV was similar in both axSpA subgroups, but lowered in controls. In nr-axSpA, CRPM correlated with CRP (ρ=0.33, p<0.001) and VICM (ρ=0.29, p=0.001); in AS, VICM correlated with CRP (ρ=0.34, p=0.0032) and ESR (ρ=0.38, p<0.001). ASDAS-CRP correlated with CRPM and anti-MCV, but when adjusting for CRP the correlation only remained with CRPM. CRPM and VICM separated the subgroups with odds ratios of 1.19 and 1.10 adjusted for age, gender, BMI, and disease duration. VICM lost significance when adjusting for CRP.

CRPM was associated with disease activity in axSpA, and CRPM and VICM separated the axSpA groups. This study indicates that serological biomarkers may be novel biomarkers in axSpA.