A study of high sensitive C-reactive protein in rheumatoid arthritis patients
DOI:
https://doi.org/10.18203/2320-6012.ijrms20205832Keywords:
Rheumatoid arthritis, High sensitive C-reactive protein, Disease modifying anti-rheumatoid drugsAbstract
Background: Rheumatoid arthritis (RA) is not only merely limited to joints but has many extraarticular features. The major cause of mortality in RA is cardiovascular disease (CVD). Inflammation in RA predispose them to succumb to CVD. The aim of this study to observe whether therapy with disease-modifying anti-rheumatic drugs (DMARD) decreases inflammation and if it does so than it can be said that decrease the risk to develop CVD. Aim and objectives were to assess hs-CRP level in early and established RA both at diagnosis and again at 3 months of DMARD therapy and compare between them.
Methods: Total 58 early RA (group A) and 58 established (group B) DMARD naïve RA patients were included in the study. Age, BMI, haemoglobin, random blood sugar, lipid profile, ESR, hs-CRP, RA factor and anti-CCP were measured. All of them were treated with DMARD and hs-CRP was again assessed after 3 months.
Results: The mean hs-CRP level at diagnosis was 6.14±1.90 mg/l in group A while it was 10.39±3.13 mg/l in group B. The mean hs-CRP level after 3 months of DMARD was 2.56±1.35mg/l in group A while it was 7.91±3.13 mg/l in group B. The mean reduction in hs-CRP level in early RA (3.58±0.99 mg/l) was statistically significantly (p<0.001) higher than that in established RA (2.48±0.09 mg/l).
Conclusions: DMARD decreases level of inflammation in RA more efficiently if initiated early in the course of the disease.
References
Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison's principles of internal medicine (19th edition.). New York: McGraw Hill Education. 2015.
Nicola PJ, Crowson CS, Maradit-Kremers H, Balman KV, Roger VL, Jacobsen SJ et al. Contribution of congestive heart failure and ischemic heart disease to excess mortality in rheumatoid arthritis. Arthrit Rheum. 2006;54(1):60-7.
Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;342:836-43.
Liuzzo G, Biasucci LM, Gallimore JR, Grillo RL, Rebuzzi AG, Pepys MB et al. The prognostic value of C-reactive protein and serum amyloid a protein in severe unstable angina. N Engl J Med. 1994;331:417-24.
Singh JA, Saag KG, Bridges SL Jr, Akl EA, Bannuru RR, Sullivan MC et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2016;68(1):1-26.
Del Rincon I, O‘Leary DH, Freeman GL, Escalante A. Acceleration of atherosclerosis during the course of rheumatoid arthritis. Atherosclerosis. 2007;195(2):354-60.
Hannawi S, Haluska B, Marwick TH, Thomas R. Atherosclerotic disease is increased in recent-onset rheumatoid arthritis: a critical role for inflammation. Arthritis Res Ther. 2007;9(6):R116.
Barragán-Martínez C, Amaya-Amaya J, Pineda-Tamayo R, Mantilla RD, Castellanos-de la Hoz J, Bernal-Macias S et al. Gender differences in Latin-American patients with rheumatoid arthritis. Gend Med. 2012;9(6):490-510.
Orr CK, Najm A, Young F, McGarry T, Biniecka M, Fearon U et al. The Utility and Limitations of CRP, ESR and DAS28-CRP in Appraising Disease Activity in Rheumatoid Arthritis. Front. Med. 2018;5:185.
Kervinen H, Palosuo T, Manninen V, Tenkanen L, Vaarala O, Manttari M. Joint effects of C-reactive protein and other risk factors on acute coronary events. Am Heart J. 2001;141:580.
Koenig W, Löwel H, Baumert J, Meisinger C. C-reactive protein modulates risk prediction based on the Framingham Score: implications for future risk assessment: results from a large cohort study in southern Germany. Circulation. 2004;109:1349.
Ismaili H, Ismaili L, Rexhepi M. Values and Correlations between C-Reactive Protein and Apolipoprotein B after Treatment with Methotrexate at Patients with Rheumatoid Arthritis. Open Acce Maced J Med Sci. 2019;7(8):1293-8.
Mäkinen H, Kautiainen H, Hannonen P, Möttönen T, Leirisalo-Repo M, Laasonen L et al. Sustained remission and reduced radiographic progression with combination disease modifying antirheumatic drugs in early rheumatoid arthritis. J Rheumatol. 2007;34:316-21.
Nell VP, Machold KP, Eberl G, Stamm TA, Uffmann M, Smolen JS. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatol. 2004;43:906-14.
Smolen JS, Landewé R, Breedveld FC, Buch M, Burmester G, Dougados M et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis. 2014;73:492-509.
