Evaluation of netrin 1 as a new biomarker in the differentiation of psoriatic arthritis from psoriasis

Sep 29, 2026

Study evaluating netrin 1, CRP, and ESR biomarkers for distinguishing psoriatic arthritis (PsA) from psoriasis using a cohort of 44 PsA and 44 psoriasis patients. PsA classification used CASPAR criteria and psoriasis severity used PASI. Serum netrin 1 and ESR were comparable overall, while netrin 1 was higher in PsA with axial involvement. CRP was higher in PsA, with a reported cut-off improving sensitivity but showing limited specificity, suggesting different biomarker performance and subtype discrimination potential.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Introduction

Biomarker background

Study rationale

[www. nature.com/scientificreports](www. nature.com/scientificreports) OPEN Evaluation of netrin 1 as a new biomarker in the differentiation of psoriatic arthritis from psoriasis Ahmet Kor1􀀍, MerveYalçın2, Funda Erduran3, Funda Eren4, Serdar Can Güven5, Hatice Ecem Konak5 & Şükran Erten6 This study aimed to evaluate the utility of netrin 1, CRP (C-reactive protein), and ESR (erythrocyte sedimentation rate) biomarkers for distinguishing between psoriatic arthritis (PsA) and psoriasis. This study included 44 patients with PsA and 44 with psoriasis. CASPAR (-Classification criteria for psoriatic arthritis) was used to classify PsA patients, and the PASI (-Psoriasis Area and Severity Index) was used to determine the degree of psoriatic plaques. Serum netrin 1 levels were measured using a commercial, ready-to-use ELISA kit that employs a quantitative immunoassay. Serum netrin 1 and ESR levels were similar between the PsA and psoriasis groups, but the median netrin 1 values were significantly higher in the PsA subtype with axial involvement than in the non-PsA subtype (respectively, 69.9 [64.0–97.6], 58.7 [56.2–64.0], p: 0.002). CRP levels were significantly higher in the PsA group than in the psoriasis group (B: − 0.134, OR [95% CI]: 0.874 [0.783–0.977], p: 0.018). A cut-off value of 12.05 for CRP was found to have a specificity of 27.3% and a sensitivity of 97.7% in distinguishing patients with PsA from those with psoriasis (AUC [95% CI]: 0.699 [0.590–0.809], p: 0.01) . Netrin 1 is not a significant biomarker for distinguishing PsA from psoriasis, but it may be a potential biomarker for identifying the PsA subtype with axial involvement. Although CRP is a sensitive biomarker for distinguishing PsA from psoriasis, its specificity is low. Keywords Netrin 1, Psoriatic arthritis, Psoriasis, Biomarker Introductıon Psoriatic arthritis (PsA), a chronic inflammatory disease, is observed in approximately one-third of patients with psoriasis and affects approximately 0.7% of the general population1,2. PsA characteristically affects the axial skeleton, peripheral joints, and entheseal areas. It can present with various clinical symptoms, and diagnosis and treatment are often delayed due to the absence of disease-specific clinical signs and symptoms. PsA causes destructive and progressive joint damage, leading to permanent loss of function and decreased quality of life3,4. Although PsA may develop in one-third of patients with psoriasis, the prevalence of undiagnosed PsA in the setting of psoriasis is approximately 10–15%4. Although classification criteria for PsA are used in academic studies, there are currently no accepted criteria or biomarkers for diagnosing PsA4. Clinical symptoms in PsA are not specific for the disease, and acute-phase reactants maybe normal, particularly in those with axial involvement. Although clinical features such as nail changes, psoriatic plaques on the scalp and intergluteal-perianal area, and the extent of psoriatic lesions may predict the development of PsA in psoriasis, these predictors are not sufficient to distinguish between psoriasis and PsA5–7. Numerous biomarker studies have aimed to distinguish PsA from psoriasis. These studies have evaluated cartilage oligomeric metalloproteinase, MMP3 (matrix metalloproteinase-3 ), receptor activator of nuclear kappa-B ligand, osteoprotegerin, dickkopf-1, human leukocyte antigen, anti-cyclic citrullinated peptide, antimutated citrullinated vimentin, anti-A disintegrin and thrombospondin motif metalloproteinase-5, anticathelicidin LL37, C.X.C motif chemokine ligand 10, and calprotectin molecules as biomarkers. However, the 1Department of Rheumatology, Aksaray Training and Research Hospital, Aksaray University, New Industry neighbourhood, Tacin Street, No. 24, Aksaray, Turkey. 2Department of Internal Medicine, Ministry of Health, Ayvacık State Hospital, Çanakkale, Turkey. 3Department of Dermatology, Ministry of Health, Ankara Bilkent City Hospital, An

FAQs

What was the purpose of evaluating netrin 1, CRP, and ESR in this study?

To assess whether serum netrin 1, CRP, and ESR can distinguish psoriatic arthritis (PsA) from psoriasis, and to explore subtype-related utility.

How many patients were included, and how were PsA and psoriasis severity defined?

The study included 44 patients with PsA and 44 with psoriasis. PsA was classified using CASPAR criteria, and psoriasis severity was measured using PASI.

What did the study find about netrin 1 and ESR for distinguishing PsA from psoriasis?

Serum netrin 1 and ESR levels were similar between the PsA and psoriasis groups overall, but netrin 1 was higher in the PsA subtype with axial involvement.

How did CRP perform as a diagnostic marker, and what limitation was noted?

CRP levels were higher in the PsA group, and a CRP cut-off of 12.05 showed very high sensitivity. Specificity was low, limiting overall discriminative accuracy.

Sep 29, 2026

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