Value of ischemia-modified albumin in ankylosing spondylitis

Ischemia-modified albumin in ankylosing spondylitis



ankylosing spondylitis, disease activity, ischemia-modified albumin, oxidative stress


Background/Aim: Ankylosing spondylitis (AS) is a chronic inflammatory illness with a poorly known pathogenesis. Current biomarkers that are used to estimate inflammation are normal in some patients despite having active disease. Recent studies have revealed that oxidative stress may have a role in AS and that there is a close relationship between oxidative stress and inflammation. Ischemia-modified albumin (IMA) is a promising new biomarker for oxidative stress. Thus, the aim of this study was to assess IMA levels and their relationship with disease activity and other inflammatory markers in patients with AS.

Methods: This prospective case-control study included 48 patients with AS and 25 healthy controls (HCs). The measured serum levels of IMA, interleukin (IL)-17, and IL-23 were compared between patients with AS and the HC group. We also analyzed the correlation between IMA and disease activity, acute phase reactants, and HLA-B27 positivity. The Ankylosing Spondylitis Disease Activity Score with C-Reactive Protein (ASDAS-CRP) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were used to determine disease activity.

Results: There was no difference in serum IMA levels between the AS and HC groups (25.08 [20.49-46.83] vs. 29.89 [29.89-42.0], P=0.146). Only IL-23 was significantly higher in patients with AS (10.81 [7.25-14.06] vs. 7.95 [6.85-10.46], P=0.039). Furthermore, there was no correlation between IMA and IL-23, IL-17, CRP, ESR, BASDAI, or ASDAS-CRP (r=-0.079, P=0.593; r=-0.043, P=0.771; r=-0.018, P=0.906; r=0.047, P=0.751; r=0.281, P=0.053; r=0.162, P=0.271). There was no significant difference between IMA, IL-17, and IL-23 levels in patients with low disease activity (BASDAI <4, ASDAS-CRP <2.1) and high disease activity (BASDAI ≥4, ASDAS-CRP ≥2.1) (BASDAI: P=0.146, P=0.303, P=0.071, and ASDAS-CRP: P=0.451, P=0.410, P=0.324, respectively). There was no difference in IMA levels between HLA-B27-positive patients and HLA-B27-negative patients (P=0.070).

Conclusion: Although oxidative stress has been suggested to play a role in AS pathogenesis, we did not find an increase in serum levels of IMA, an oxidative stress biomarker, in patients with AS. Our results suggest that IMA may not be a reliable indicator of inflammation. Further research is needed to determine whether IMA may have a role as a biomarker in AS.


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Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2017;369(9570):1379-90. doi: 10.1016/S0140-6736(07)60635-7. DOI:

Zhu W, He X, Cheng K, Zhang L, Chen D, Wang X, et al. Ankylosing spondylitis: etiology, pathogenesis, and treatments. Bone Res. 2019;7:22. doi: 10.1038/s41413-019-0057-8. DOI:

Halliwell B. Antioxidants in human health and disease. Annu Rev Nutr. 1996;16:33-50. doi: 10.1146/ DOI:

Danaii S, Abolhasani R, Soltani-Zangbar MS, Zamani M, Mehdizadeh A, Aminafar B, et al. Oxidative stress and immunological biomarkers in Ankylosing spondylitis patients. Gene Reports. 2020;18:100574. doi: 10.1016/j.genrep.2019.100574. DOI:

Pishgahi A, Abolhasan R, Danaii S, Amanifar B, Soltani-Zangbar MS, Zamani M, et al. Immunological and oxidative stress biomarkers in Ankylosing Spondylitis patients with or without metabolic syndrome. Cytokine. 2020;128:155002. doi: 10.1016/j.cyto.2020.155002. DOI:

Biasi D, Carletto A, Caramaschi P, Bellavite P, Andrioli G, Caraffi M, et al. Neutrophil functions, spondylarthropathies and HLA-B27: a study of 43 patients. Clin Exp Rheumatol. 1995;13(5):623-7.

Shevtsova A, Gordiienko I, Tkachenko V, Ushakove G. Ischemia-Modified Albumin: Origins and Clinical Implications. Dis Markers. 2021:9945424. doi: 10.1155/2021/9945424. DOI:

Sbarouni E, Georgiadou P, Voudris V. Ischemia modified albumin changes-review and clinical implications. Clin Chem Lab Med. 2011;49(2):177-84. doi: 10.1515/CCLM.2011.037. DOI:

Li JX, Liu SL, Cui Y. Oxidative and antioxidative stress linked biomarkers in ankylosing spondylitis: a systematic review and meta-analysis. Oxid Med Cell Longev. 2020:1-10. doi: 10.1155/2020/4759451. DOI:

van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27(4):361-8. doi: 10.1002/art.1780270401. DOI:

Sertpoyraz FM, Colak A, Dikici A, Gunduz NE, Aksit MZ. The relationship of ischemia-modified albumin levels to disease activity scores and HLA-B27 in patients with ankylosing spondylitis. North Clin Istanb. 20208(1):42-8. doi: 10.14744/nci.2020.23590. DOI:

Türkön H, Gökmen F, Çakir DÜ, Sehitoğlu MH, Reşorlu H, Döner D, et al. Increased Levels of Serum Ischemia Modified Albumin in Patients with Ankylosing Spondylitis. Clin Lab. 2016;62(4):645-9. DOI:

Zuo L, Prather ER, Stetskiv M, Garrison DE, Meade JR, Peace TI, et al. Inflammaging and Oxidative Stress in Human Diseases: From Molecular Mechanisms to Novel Treatments. Int J Mol Sci. 2019;20(18):4472. doi: 10.3390/ijms20184472. DOI:

Karakoc M, Altindag O, Keles H, Soran N, Selek S. Serum oxidative-antioxidative status in patients with ankylosing spondylitis. Rheumatol Int. 2007;27(12):1131-4. doi: 10.1007/s00296-007-0352-38. DOI:

Fialkow L, Wang Y, Downey GP. Reactive oxygen and nitrogen species as signaling molecules regulating neutrophil function. Free Radic Biol Med. 2007; 42(2):153-64. doi: 10.1016/j.freeradbiomed.2006.09.030. DOI:

Biswas SK. Does the Interdependence between Oxidative Stress and Inflammation Explain the Antioxidant Paradox? Oxid Med Cell Longev. 2016:5698931. doi: 10.1155/2016/5698931. DOI:

Jones DP, Carlson JL, Mody VC, Cai J, Lynn MJ, Sternberg P. Redox state of glutathione in human plasma. Free Radic Biol Med. 2000;28(4):625-35. doi: 10.1016/s0891-5849(99)00275-0. DOI:

Jones DP. Redefining oxidative stress. Antioxid Redox Signal. 2006;8(9-10):1865-79. doi: 10.1089/ars.2006.8.1865. DOI:

Tel Adıgüzel K, Yurdakul FG, Kürklü NS, Yaşar E, Bodur H. Relationship between diet, oxidative stress, and inflammation in ankylosing spondylitis. Arch Rheumatol. 2022;37(1):1-10. DOI:

Yazici C, Köse K, Calis M, Kuzugüden S, Kirnap M. Protein oxidation status in patients with ankylosing spondylitis. Rheumatology (Oxford). 2004;43(10):1235-9. doi: 10.1093/rheumatology/keh317. DOI:

Ozgocmen S, Sogut S, Ardicoglu O, Fadillioglu E, Pekkutucu I, Akyol O. Serum nitric oxide, catalase, superoxide dismutase, and malondialdehyde status in patients with ankylosing spondylitis. Rheumatol Int. 2004;24(2):80-3. doi: 10.1007/s00296-003-0335-y. DOI:

Bar-Or D, Curtis G, Rao N, Bampos N, Lau E. Characterization of the Co(2+) and Ni(2+) binding amino-acid residues of the N-terminus of human albumin. An insight into the mechanism of a new assay for myocardial ischemia. Eur J Biochem. 2001;268(1):42-7. doi: 10.1046/j.1432-1327.2001.01846.x. DOI:

Kaefer M, Piva SJ, De Carvalho JA, Da Silva DB, Becker AM, Coelho AC, et al. Association between ischemia modified albumin, inflammation and hyperglycemia in type 2 diabetes mellitus. Clin Biochem. 2010;43(4-5):450-4. doi: 10.1016/j.clinbiochem.2009.11.018. DOI:

Borderie D, Allanore Y, Meune C, Devaux JY, Ekindjian OG, Kahan A. High ischemia-modified albumin concentration reflects oxidative stress but not myocardial involvement in systemic sclerosis. Clin Chem. 2004;50(11):2190-3. doi: 10.1373/clinchem.2004.034371. DOI:

Leitemperguer MR, Tatsch E, Kober H, De Carvalho JA, Moresco RN, Da Silva JE. Assessment of ischemia-modified albumin levels in patients with rheumatoid arthritis. Clin Lab. 2014;60(6):1065-70. doi: 10.7754/clin.lab.2013.130143. DOI:

Uslu AU, Kucuk A, Balta S, Ozturk C, Arslan S, Tekin L, et al. The relation between ischemia-modified albumin levels and carotid intima-media thickness in patients with rheumatoid arthritis. Int J Rheum Dis. 2019;22(1):32-7. doi: 10.1111/1756-185X.12851. DOI:

Fouad NA, Ahmed TI, Shaker OG, Abdelaleem OO. Relation of ischemia-modified albumin to disease manifestations and activity in Egyptian patients with Behҫet’s disease. Egypt Rheumatol Rehabil. 2019;46:108–12. doi: 10.4103/err.err_66_18. DOI:

Ermurat S, Güler Kazanci E, Toka DI, Ayar K, Eren FK, Neşelioğlu S. Evaluation of thiol/disulfide hemostasis and serum Ischemia modified albumin as oxidative stress biomarkers in systemic lupus erythematosus patients: Relationship with major organ involvement and disease activity. Lupus. 2022;31(11):1355-66. doi: 10.1177/09612033221115628. DOI:

Gökmen F, Türkön H, Akbal A, Reşorlu H, Savaş Y, Reşorlu M, et al. The relationship between inflammatory parameters and atherosclerosis with ischemic modified albumin levels in Sjögren syndrome. Selçuk Tıp Derg. 2015;31:20–3.

Ahn SS, Yoon T, Song JJ, Park YB, Lee SW. Serum albumin, prealbumin, and ischemia-modified albumin levels in patients with ANCA-associated vasculitis: A prospective cohort study. PLoS One. 2022;17(7):e0271055. doi: 10.1371/journal.pone.0271055. DOI:

Layh-Schmitt G, Colbert RA. The interleukin-23/interleukin-17 axis in spondyloarthritis. Curr Opin Rheumatol. 2008;20(4):392-7. doi: 10.1097/BOR.0b013e328303204b. DOI:

Chen WS, Chang YS, Lin KC, Lai CC, Wang SH, Hsiao KH, et al. Association of serum interleukin-17 and interleukin-23 levels with disease activity in Chinese patients with ankylosing spondylitis. J Chin Med Assoc. 2012;75(7):303-8. doi: 10.1016/j.jcma.2012.05.006. DOI:

Mei Y, Pan F, Gao J, Ge R, Duan Z, Zeng Z, et al. Increased serum IL-17 and IL-23 in the patient with ankylosing spondylitis. Clin Rheumatol. 2011;30(2):269-73. doi: 10.1007/s10067-010-1647-4. DOI:

Deveci H, Caglıyan Turk A, Ozmen ZC, Deveci K. Serum Interleukin-23/17 Levels in Ankylosing Spondylitis Patients Treated with Nonsteroidal Anti-Inflammatory Drugs: A Prospective Cohort Study. J Interferon Cytokine Res 2019;39(9):572-6. doi: 10.1089/jir.2019.00529. DOI:

Milanez FM, Saad CG, Viana VT, Moraes JC, Périco GV, Sampaio-Barros PD, et al. IL-23/Th17 axis is not influenced by TNF-blocking agents in ankylosing spondylitis patients. Arthritis Res Ther. 2016;18:52. doi: 10.1186/s13075-016-0949-6. DOI:

Sherlock JP, Joyce-Shaikh B, Turner SP, Chao CC, Sathe M, Grein J, et al. IL-23 induces spondyloarthropathy by acting on ROR-γt+ CD3+CD4−CD8− entheseal resident T cells. Nat Med. 2012;18(7):1069-76. doi: 10.1038/nm.2817. DOI:






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Orucoglu Yildirim N, Balcı S, Tamer L. Value of ischemia-modified albumin in ankylosing spondylitis: Ischemia-modified albumin in ankylosing spondylitis. J Surg Med [Internet]. 2023 Sep. 19 [cited 2024 May 25];7(9):590-4. Available from: