Clinical disease activity and acute phase reactant levels are discordant among patients with active rheumatoid arthritis: acute phase reactant levels contribute separately to predicting outcome at one yearReportar como inadecuado




Clinical disease activity and acute phase reactant levels are discordant among patients with active rheumatoid arthritis: acute phase reactant levels contribute separately to predicting outcome at one year - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Arthritis Research and Therapy

, 16:R40

First Online: 03 February 2014Received: 09 April 2013Accepted: 24 January 2014

Abstract

IntroductionClinical trials of new treatments for rheumatoid arthritis RA typically require subjects to have an elevated acute phase reactant APR, in addition to tender and swollen joints. However, despite the elevation of individual components of the Clinical Disease Activity Index CDAI tender and swollen joint counts and patient and physician global assessment, some patients with active RA may have normal erythrocyte sedimentation rate ESR and-or C-reactive protein CRP levels and thus fail to meet entry criteria for clinical trials. We assessed the relationship between CDAI and APRs in the Consortium of Rheumatology Researchers of North America CORRONA registry by comparing baseline characteristics and one-year clinical outcomes of patients with active RA, grouped by baseline APR levels.

MethodsThis was an observational study of 9,135 RA patients who had both ESR and CRP drawn and a visit at which CDAI was >2.8 not in remission.

ResultsOf 9,135 patients with active RA, 58% had neither elevated ESR nor CRP; only 16% had both elevated ESR and CRP and 26% had either ESR or CRP elevated. Among the 4,228 patients who had a one-year follow-up visit, both baseline and one-year follow-up modified Health Assessment Questionnaire mHAQ and CDAI scores were lowest for patients with active RA but with neither APR elevated; both mHAQ and CDAI scores increased sequentially with the increase in number of elevated APR levels at baseline. Each individual component of the CDAI followed the same trend, both at baseline and at one-year follow-up. The magnitude of improvement in both CDAI and mHAQ scores at one year was associated positively with the number of APRs elevated at baseline.

ConclusionsIn a large United States registry of RA patients, APR levels often do not correlate with disease activity as measured by joint counts and global assessments. These data strongly suggest that it is appropriate to obtain both ESR and CRP from RA patients at the initial visit. Requiring an elevation in APR levels as a criterion for inclusion of RA patients in studies of experimental agents may exclude some patients with active disease.

AbbreviationsAPRacute phase reactant

CDAIClinical Disease Activity Index

CORRONAConsortium of Rheumatology Researchers of North America

CRPC-reactive protein

DASDisease Activity Score

DMARDdisease-modifying antirheumatic drug

ESRerythrocyte sedimentation rate

HAQ-DIHealth Assessment Questionnaire Disability Index

mHAQmodified Health Assessment Questionnaire

MTXmethotrexate

RArheumatoid arthritis

SDAISimplified Disease Activity Index.

Electronic supplementary materialThe online version of this article doi:10.1186-ar4469 contains supplementary material, which is available to authorized users.

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Autor: Jonathan Kay - Olga Morgacheva - Susan P Messing - Joel M Kremer - Jeffrey D Greenberg - George W Reed - Ellen M Grava

Fuente: https://link.springer.com/



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