Implication of baseline levels and early changes of C-reactive protein for subsequent clinical outcomes of patients with rheumatoid arthritis treated with tocilizumab

2020 ◽  
Vol 79 (7) ◽  
pp. 874-882
Author(s):  
Inbal Haya Shafran ◽  
Farideh Alasti ◽  
Josef S Smolen ◽  
Daniel Aletaha
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Inflammatory Responses ◽  
Activity Index ◽  
Disease Activity Index ◽  
Positive Association ◽  
C Reactive Protein ◽  
Therapeutic Success ◽  
Reactive Protein ◽  
Early Ra

BackgroundRheumatoid arthritis (RA) is characterised by clinical joint swelling and elevation of acute phase reactant levels, typically measured by the C-reactive protein (CRP). Clinical and inflammatory responses are usually concordant, except for inhibition of IL-6, which often disproportionally reduces the CRP due to direct inhibition of its hepatic production. We investigated whether pre-treatment CRP is a useful marker that can guide a preferential treatment choice towards IL-6 inhibition.MethodsData of 1126 treatment courses with tocilizumab (TCZ; early RA), 250 courses of rituximab (RTX; established RA) and 249 courses of methotrexate (MTX; established RA) were analysed. We compared clinical disease activity index (CDAI) values and change along 24 weeks’ follow-up to CRP values at baseline or its early change. We validated the results using data from a separate TCZ trial in early RA.ResultsCRP levels in the TCZ group on average dropped by 74% within 4 weeks. Patients who attained CDAI remission at 24 weeks on TCZ had the highest baseline CRP levels while patients in high disease activity had the lowest; this association was reverse in the RTX and MTX groups. TCZ patients who achieved remission at 24 weeks showed the largest reductions of CRP levels by week 4 compared with those reaching higher disease activity states. Early CRP non-response was indicative of a risk of not achieving clinical treatment goals (p=0.038).ConclusionBaseline CRP appears to have a positive association with reaching the therapeutic target on TCZ treatment, but is a negative predictor for RTX and MTX. Patients on TCZ without an early CRP response have a lower chance of achieving remission. CRP and its early course may inform, to some extent, the estimation of potential therapeutic success in patients with RA.

scholarly journals Serum C-reactive protein level does not correlate with Crohn’s Disease Activity Index

2010 ◽  
Vol 5 ◽  
pp. 274-278
Author(s):  
Maciej Kohut ◽  
Katarzyna Kozioł ◽  
Emilia Olek ◽  
Anna Koclęga ◽  
Marek Hartleb
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Protein Level ◽  
Activity Index ◽  
Disease Activity Index ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Crohn’S Disease Activity

AB0233 ATTAINING CDAI REMISSION IS THE FIRST GATEWAY TO ATTAIN BOOLEAN REMISSION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1417.1-1417
Author(s):  
I. Yoshii
Keyword(s):  
Disease Activity ◽  
Sex Education ◽  
Global Assessment ◽  
Activity Index ◽  
Disease Activity Index ◽  
Pain Scale ◽  
Treat To Target ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Hands And Feet

Background:Boolean remission is most stringent but most comparable remission status for the patient with rheumatoid arthritis (RA). Clinical remission evaluated with clinical disease activity index (CDAI) is also one of the most popular index for evaluation of RA treatment. These two criteria often overlap, but some are split.Objectives:Clinical significance of attaining CDAI remission before attaining Boolean remission was investigated.Methods:Patient with RA were treated in the institute since August 2010 under treat to target (T2T) strategy. In accordance with T2T, RA patients were monitored from the first consultation with parameter such as tenderness joint count (TJC), swollen joint count (SJC), patient’s global assessment (PGA), evaluator’s global assessment (EGA), C-reactive protein (CRP), modified Health Assessment Questionnaire (mHAQ), pain scale with visual analog scale (PS-VAS), and EuroQOL 5-dimension (EQ-5D). CDAI and Boolean are also evaluated at the same time. Radiographs of bilateral hands and feet are taken once a year from the first consultation, and the Sharp/van der Heijde Score (SHS) is measured.In patients, a group who attained CDAI remission prior to attaining Boolean remission (CDAI-R), a group who could not attain CDAI remission previously than attaining Boolean remission (CDAI-F), and a group who could not attain Boolean remission despite attaining CDAI remission (Boolean-F) were picked up and divided according to change of disease activity. Among these three groups, mean age, sex, education level, job style, anti-cyclic citrullinated polypeptide antibodies (ACPA), rheumatoid factor (RF), the CDAI score, the HAQ score, PS-VAS and quality of life index (QOL) calculated from EQ-5D were compared with each other using Mann-Whitney U-test. Boolean remission attaining rate whether CDAI remission attained was compared with chi square test.Results:Patient group configured with 255 of CDAI-R, 160 of CDAI-F, and 28 of Boolean-F. Patient who could not attain none of CDAI nor Boolean remission counted 175. In background factors at baseline, mean age, the HAQ score, and SHS of the Boolean-F were significantly older than the other groups. In the two groups of CDAI-R and CDAI-F, 28-joints disease activity score with C-reactive protein (DAS28-CRP), CDAI and PS-VAS in the CDAI-R were significantly lower than in the CDAI-F, similarly, DAS28-CRP, the CDAI score, the HAQ score, PS-VAS and QOL after Boolean remission attain were significantly higher in the CDAI-F than the CDAI-R. Sensitivity of Boolean remission when attaining CDAI remission previously before Boolean remission is 93.4%, and specificity was 52.2% (p<1.0x10-30).Conclusion:Attaining CDAI remission previously is extremely important, both for attaining Boolean remission and more stable clinical course after attaining Boolean remission. CDAI remission could be the first gateway to send sustainable QOL course.Disclosure of Interests:None declared

scholarly journals Serum chitotriosidase and neopterin levels in patients with ankylosing spondylitis

2019 ◽  
Vol 11 ◽  
pp. 1759720X1983232 ◽  
Author(s):  
Ferdi Yavuz ◽  
Bilge Kesikburun ◽  
Özlem Öztürk ◽  
Ümüt Güzelküçük
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Activity Index ◽  
Multiple Logistic Regression Analysis ◽  
Disease Activity Index ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Positive Correlations ◽  
Positive Significant Correlation

Background: The aim of this study was to assess the serum chitotriosidase (ChT) and neopterin levels in patients with ankylosing spondylitis (AS) and to evaluate whether serum ChT and neopterin levels are related to disease activity. Methods: A total of 86 patients with AS were included in the study. Patients were divided into two groups based on Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores: The active AS patients group included 40 patients who had a BASDAI score ⩾4. The inactive AS patients group included 46 patients who had a BASDAI score <4. We compared the serum level of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ChT and neopterin between the two groups. Results: Active AS patients had significantly higher ESR, CRP, serum ChT and neopterin levels compared with the inactive AS patients group ( p < 0.05). Positive correlations were found between serum ChT levels and ESR ( r = 0.87, p = 0.005), and CRP levels ( r = 0.86, p = 0.006). Also, there was a positive significant correlation between serum ChT levels and BASDAI scores ( r = 0.67, p = 0.03). No correlation was found between serum neopterin levels and the BASDAI scores, ESR, and CRP levels ( p > 0.05). Higher disease activity (BASDAI score ⩾4) was found to be associated with ChT ( p = 0.012) in the multiple logistic regression analysis. Conclusion: The present study emphasized that serum ChT levels can be useful in the determination of the disease activity of AS patients.

scholarly journals The serum C-reactive protein to prealbumin ratio and fibrinogen to prealbumin ratio are two relevant indicators for evaluating the disease activity of ankylosing spondylitis

2021 ◽  
Vol 19 ◽  
pp. 205873922110140
Author(s):  
Kai Zhang ◽  
Junhao Wang ◽  
Jinhong Chen ◽  
Zhi Li ◽  
Zhaohui Lou
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Activity Index ◽  
Area Under The Curve ◽  
Test Group ◽  
Disease Activity Index ◽  
Biological Indicators ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Spearman Test

The C-reactive protein to prealbumin ratio (CPR) and fibrinogen to prealbumin ratio (FPR) in serum are two emerging biomarkers. The purpose of this study is to explore the relationship between these two markers and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Scores (ASDAS). A total of 163 patients with AS and 120 healthy examinees were included in this study. The t-test and Mann-Whitney U ranking test were used to analyze the differences between groups. The spearman-test was used to analyze the correlation between erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), fibrinogen (Fib), prealbumin (PAlb), CPR, FPR, and AS disease activity in the test group. We generated the receiver operating characteristic curves (ROC) of CPR and FPR and determined the discriminating ability by calculating the area under the curve (AUC). Compared with the healthy group, ESR ( p < 0.001), CRP ( p < 0.001), Fib ( p < 0.001), CPR ( p < 0.001), and FPR ( p < 0.001) of AS patients were significantly increased, while PAlb was significantly reduced. CPR and FPR were more correlated to ASDAS-CRP. CPR was positively correlated with CRP, ESR, BASDAI, and ASDAS-CRP in AS patients ( r = 0.959, p < 0.001, r = 0.717, p < 0.001, r = 0.704, p < 0.001, r = 0.763, p < 0.001). FPR was positively correlated with CRP, ESR BASDAI, and ASDAS-CRP in AS patients ( r = 0.779, p < 0.001, r = 0709, p < 0.001, r = 0.551, p < 0.001, r = 0.763, p < 0.001). ROC showed that the AUC levels of CPR and FPR were high (AUC = 0.952 and AUC = 0.893). CPR and FPR are two promising new biological indicators for assessing disease activity in AS patients.

Sign in / Sign up

Export Citation Format

Share Document