Parathyroid hormone-related peptide in synovial fluid and disease activity of rheumatoid arthritis

To understand the clinical role of parathyroid hormone-related peptide (PTHrP) in rheumatoid arthritis (RA), we analysed the circulatory and synovial fluid (SF) concentrations of the N- and C-terminal regions of PTHrP (N- and C-PTHrP) in RA (n = 38), osteoarthritis (OA, n = 45) and control (n = 11) subjects. The SF level of C-PTHrP was markedly higher in RA compared with control and OA groups, while no differences in circulatory C-PTHrP were present among the three groups. In contrast, the SF level of N-PTHrP was marginally higher in OA patients. C-PTHrP levels in SF correlated significantly with CRP, ESR and SF IL-1 receptor antagonist. To identify the mechanism of elevated PTHrP levels in SF, immunohistochemistry and in situ hybridization of synovial membrane (SM) were performed in each subject. Overexpression of PTHrP was identified in the sublining cells within papillary proliferated SM of RA patients only. Our results indicate that C-PTHrP produced from SM into SF reflects the disease activity in RA.