Ali Erhan Özdemirel1, Serdar Can Güven2, Zühre Sarı Sürmeli3, Ayla Özyuvalı4, Memet Kurt5, Diana Rüstemova6, Ayşe Peyman Yalçın Sayan7, Hüseyin Tutkan8, Şebnem Ataman9

1Department of Rheumatology, Liv Hospital, Ankara, Türkiye
2Department of Rheumatology, Ankara City Hospital, Ankara, Türkiye
3Department of Rheumatology, Memorial Şişli Hospital, İstanbul, Türkiye
4Department of Physical and Rehabilitation Medicine, HFM Beyazpınar Physical Medicine and Rehabilitation Centre, Ankara, Türkiye
5Department of Physical and Rehabilitation Medicine, Dr. Ergun Özdemir Görele State Hospital, Giresun, Türkiye
6Department of Physical and Rehabilitation Medicine, Can Private Hospital Clinic of Physical and Rehabilitation, Manisa, Türkiye
7Department of Physical and Rehabilitation Medicine, Ankara University Faculty of Medicine, Ankara, Türkiye
8Department of Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Türkiye
9Department of Physical and Rehabilitation Medicine, Division of Rheumatology, Ankara University Faculty of Medicine, Ankara, Türkiye

Keywords: Ankylosing spondylitis, bone morphogenetic protein, bone turnover, disease activity, rheumatoid arthritis.


Objectives: This study aims to investigate the levels of bone morphogenic proteins (BMPs), one of the pathways affecting bone turnover in these diseases, and to investigate their relationship with disease activity.

Patients and methods: Between September 2013 and July 2015, a total of 100 ankylosing spondylitis (AS) patients (53 males, 48 females; median age: 40 years; range, 18 to 62 years), 58 rheumatoid arthritis (RA) patients (25 males, 33 females; median age: 40.5 years; range, 26 to 59 years), and 102 age- and sex-matched healthy controls (55 males, 47 females; median age: 38 years; range, 18 to 55 years) were included in the study. In all groups, serum BMP-2 and BMP-4 levels were measured using enzyme-linked immunosorbent assay (ELISA). Demographic data (age, sex, duration of disease) and acute phase reactants of the patients at the final visit were recorded. Disease activity was assessed through the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score C-Reactive Protein (ASDAS-CRP) for AS patients and through the Disease Activity Score-28-CRP (DAS-28-CRP) for RA patients.

Results: The median BMP-2 values were found to be significantly higher in the RA group compared to the other groups and in the control group compared to the AS group (p<0.001 for both). There was no significant difference between the groups in terms of median BMP-4 values (p>0.05). No significant relationship was found between serum BMP-2 and BMP-4 levels and disease activity in both AS and RA patients, while there was a weak positive correlation between erythrocyte sedimentation rate and CRP levels with BMP-2 level in RA patients (p=0.014, r=0.320 and p=0.029, r=0.287, respectively).

Conclusion: Our study results suggest that the BMP pathway may have different dual effects in AS and RA patients depending on the underlying pathogenesis, and that local effects are more prominent than serum levels.

Citation: Özdemirel AE, Güven SC, Sarı Sürmeli Z, Özyuvalı A, Kurt M, Rüstemova D, et al. Serum BMP-2 and BMP-4 levels and their relationship with disease activity in patients with rheumatoid arthritis and ankylosing spondylitis. Arch Rheumatol 2022;37(3):466-474.

Ethics Committee Approval

The study protocol was approved by the Ankara University Faculty of Medicine Ethics Committee (no: 2013-04-162-13). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Concept and design: A.E.Ö., H.T., A.P.Y.S. Ş.A.; Supervision: H.T., A.P.Y.S., Ş.A.; Data collection: A.E.Ö., Z.S.S., A.Ö., M.K., D.R.; Data analysis, interpretation of the data, writing the manuscript: A.E.Ö., S.C.G.; All authors approved the final version of the manuscript.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article