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Vol. 18. Issue 2.
Pages 69-76 (February 2022)
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Vol. 18. Issue 2.
Pages 69-76 (February 2022)
Original Article
The clinical utility of faecal calprotectin in patients with differentiated and undifferentiated spondyloarthritis: Relevance and clinical implications
La utilidad clínica de la calprotectina fecal en pacientes con espondiloartritis diferenciada e indiferenciada: relevancia e implicaciones clínicas
Yasser Emada,
Corresponding author

Corresponding author.
, Yasser Ragabb, Nevin Hammamc,d, Nashwa El-Shaarawye, Magdy Fawzif, Arwa Amerg, Hesham El-Makhzangyh, Ahmed Ismaili, Ossama Ibrahimj, Yosra Hassank, Ahmed Kamall, Johannes J. Raskerm
a Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
b Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
c Rheumatology and Rehabilitation Department, Faculty of Medicine, AssiutUniversity, Assiut, Egypt
d Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
e Rheumatology and Rehabilitation Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
f Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
g Rheumatology, Rehabilitation and Physical MedicineDepartment, Faculty of Medicine, Benha University, Benha, Egypt
h Tropical Medicines Department, Faculty of Medicine, Cairo University, Cairo, Egypt
i Dermatology Department, Faculty of Medicine, Al-Azhar University Cairo, Egypt
j Morecambe Bay University Hospitals Lancaster, Lancashire, UK
k Clinical pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
l Orthopedic Department, Faculty of Medicine, Cairo University, Cairo, Egypt
m Faculty of Behavioural, Management and Social sciences, Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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Tables (2)
Table 1. Patients’ characteristics, laboratory investigations and endoscopic findings among the studied groups of patients.
Table 2. Laboratory findings among the studied groups of patients.
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There is cumulative evidence in the literature supporting a potential role of faecal calprotectin (FCP) as a biomarker for gut inflammation in spondyloarthritis (SpA). However its relevance in undifferentiated SpA (USpA) is still uncertain. The aim of the current study is to assess the diagnostic significance of FCP levels in patients with differentiated and undifferentiated SpA.

Material and methods

A total of 52 differentiated SpA, 33 USpA and 50 controls could be included. For all patients, clinical evaluation, routine laboratory investigations, FCP levels, and occult blood in stool were performed. When indicated imaging and/or endoscopies were performed.


The differentiated SpA patients were 12 (23.1%) with ankylosing spondylitis, 21 (40.4%) with psoriatic arthritis, 13 (25%) with ulcerative colitis, 5 (9.6%) with Crohn's disease (CD) and one (1.9%) with reactive arthritis. The mean FCP level in 85 patients correlated with CRP and ESR. Within the SpA group ulcerative colitis and Crohn's disease patients had increased FCP levels compared to other SpA subgroups and USpA patients (p<0.001). The mean FCP levelwas significantly higher in the SpA patients compared to USpA and controls (p<0.001).


Elevated FCP levels may identify patients who are most likely to have SpA already in the unclassified phase of the disease. Further studies in different series of patients are needed to evaluate the potential diagnostic and prognostic roles of FCP in both differentiated and undifferentiated phases of the disease.

Undifferentiated spondyloarthritis
Faecal calprotectin
Subclinical gut inflammation in spondyloarthritis

Existe evidencia acumulada en la literatura que respalda un papel potencial de la calprotectina faecal (FCP) como un biomarcador para la inflamación intestinal en la espondiloartritis (SpA). Sin embargo, su relevancia en SpA indiferenciada (USpA) aún es incierta. El objetivo del presente estudio es evaluar la importancia diagnóstica de los niveles de FCP en pacientes con SpA diferenciada e indiferenciada.

Material y métodos

Se incluyeron un total de 52 SpA diferenciadas, 33 USpA y 50 controles. Para todos los pacientes, se realizaron evaluaciones clínicas, investigaciones de laboratorio de rutina, niveles de FCP y sangre oculta en las heces. Cuando se indicó se realizaron imágenes y/o endoscopias.


Los pacientes con SpA diferenciada fueron 12 (23,1%) con espondilitis anquilosante, 21 (40,4%) con artritis psoriásica, 13 (25%) con colitis ulcerosa, 5 (9,6%) con enfermedad de Crohn y uno (1,9%) con artritis reactiva. El nivel medio de FCP en 85 pacientes se correlacionó con la PCR y la VSG. Dentro del grupo de SpA, los pacientes con colitis ulcerosa y enfermedad de Crohn habían aumentado los niveles de FCP en comparación con otros subgrupos de SpA y pacientes con USpA (p<0,001). El nivel medio de FCP fue significativamente mayor en los pacientes con SpA en comparación con los controles normales y USpA (p<0,001).


Los niveles elevados de FCP pueden identificar a los pacientes que tienen más probabilidades de tener SpA ya en la fase no clasificada de la enfermedad. Se necesitan más estudios en diferentes series de pacientes para evaluar las posibles funciones de diagnóstico y pronóstico del FCP en las fases diferenciadas e indiferenciadas de la enfermedad.

Palabras clave:
Espondiloartritis indiferenciada
Calprotectina faecal
Inflamación intestinal subclínica en espondiloartritis


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