Relationship Between Disease Activation, Serum Erythrocyte Sediment Level and C-reactive Protein Level in Rheumatoid Arthritis Patients Receiving Anti-Tumor Necrosis Factor Alpha Treatment
Objectives: Rheumatoid arthritis (RA) is a progressive, multisystemic disease with a course of chronic inflammation, and which is thought to be immune-originated, though the etiopathogenesis is not fully understood. Elimination of pain with adequate treatment is important in terms of preventing damage and systemic complications. As such, it is important to determine prognostic markers in the evaluation of disease activation. The goal of this study was to explore the relationship between the Disease Activity Score 28 (DAS 28), one of the disease activation indices, erythrocyte sedi-ment rate (ESR) and C-reactive protein (CRP) level.
Methods: A total of 93 patients who presented at the rheumatology polyclinic of Dr. Lütfi Kırdar Kartal Training and Research Hospital were included in the study. Of those, 46 were included in the study group (receiving anti-tumor necrosis factor alpha [TNF-α] treatment), and 47 were included in the control group (not receiving anti-TNF-α treatment). The patients enrolled did not have any malignancy or other inflammatory disease. Patients included in the study were also screened for findings of anemia, polycythemia leukocytosis, or lymphocytosis. The DAS 28 score of the study pa-tients was obtained from medical records. Biochemical analyses, as well as CRP and ESR measurements taken after 1 year, were recorded retrospectively.
Results: A statistically significant relationship was observed between the DAS 28 score and ESR in patients who received anti-TNF-α treatment, while a statistically significant relationship was not found between the DAS 28 score and CRP level. There was no statistically significant relationship in RA patients between the DAS 28 score and ESR or CRP in those who did not receive anti-TNF-α treatment.
Conclusion: According to these results, RA patients receiving anti-TNF- α treatment demonstrated a better ESR marker of disease activity in long-term follow-up.
1.Pepys MB. Aspects of the acute phase response. The C-reac-tive protein system. In : Lachmann PJ, Peters DK, editors. Clinical Aspects of Immunology. Oxford: Blackwell Scientific Publications; 1982. p. 50–71.
2. Connell L, McInnes IB. New cytokine targets in inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2006;20:865–78. [CrossRef]
3. Pay S. The use of anti-tnf drugs in rheumatic disorders: medical educaiton. Turkiye Klinikleri J Med Sci 2006;26:430–40.
4. Kushner I, Rzewnicki DL. The acute phase response: general aspects. Baillieres Clin Rheumatol 1994;8:513–30. [CrossRef]
5. Graudal N, Tarp U, Jurik AG, Galløe AM, Garred P, Milman N, et al. Inflammatory patterns in rheumatoid arthritis estimated by the number of swollen and tender joints, the erythrocyte sedimentation rate, and hemoglobin: longterm course and association to radiographic progression. J Rheumatol 2000;27:47–57.
6. Yildirim K, Karatay S, Melikoglu MA, Gureser G, Ugur M, Senel K. Associations between acute phase reactant levels and disease activity score (DAS28) in patients with rheumatoid arthritis. Ann Clin Lab Sci 2004;34:423–6.
7. Nassonov EL, Samsonov MY, Chichasova NV, Nikiphorova EL, Tilz GP, Demel U, et al. Soluble adhesion molecules in rheumatoid arthritis. Rheumatology (Oxford) 2000;39:808–10.
8. Nikiphorou E, Radner H, Chatzidionysiou K, Desthieux C, Zabalan C, van Eijk-Hustings Y, et al. Patient global assessment in measuring disease activity in rheumatoid arthritis: a review of the literature. Arthritis Res Ther 2016;18:251. [CrossRef]
9. Pinals RS, Masi AT, Larsen RA. Preliminary criteria for clinical remission in rheumatoid arthritis. Arthritis Rheum 1981;24:1308–15. [CrossRef]
10. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 Update. Arthritis Rheum 2002;46:328–46. [CrossRef]
11. Weinblatt ME, Kremer JM, Coblyn JS, Maier AL, Helfgott SM, Morrell M, et al. Pharmacokinetics, safety, and efficacy of combination treatment with methotrexate and leflunomide in patients with active rheumatoid arthritis. Arthritis Rheum 1999;42:1322–8. [CrossRef]
12. Lindqvist E, Eberhardt K, Bendtzen K, Heinegård D, Saxne T. Prognostic laboratory markers of joint damage in rheumatoid arthritis. Ann Rheum Dis 2005;64:196–201. [CrossRef]
13. Lansbury J. Report of a three-year study on the systemic and articular indexes in rheumatoid arthritis; theoretic and clinical considerations. Arthritis Rheum 1958;1:505–22. [CrossRef]
14. van Leeuwen MA, van Rijswijk MH, van der Heijde DM, Te Meerman GJ, van Riel PL, Houtman PM, et al. The acute-phase response in relation to radiographic progression in early rheumatoid arthritis: a prospective study during the first three years of the disease. Br J Rheumatol 1993;32 Suppl 3:9–13.
15. Mallya RK, de Beer FC, Berry H, Hamilton ED, Mace BE, Pepys MB. Correlation of clinical parameters of disease activity in rheumatoid arthritis with serum concentration of C-reactive protein and erythrocyte sedimentation rate. J Rheumatol 1982;9:224–8.
16. Yildirim K, Karatay S, Melikoglu MA, Gureser G, Ugur M, Senel K. Associations between acute phase reactant levels and disease activity score (DAS28) in patients with rheumatoid arthritis. Ann Clin Lab Sci 2004;34:423–6.
17. Dixon JS, Bird HA, Sitton NG, Pickup ME, Wright V. C-reactive protein in the serial assessment of disease activity in rheumatoid arthritis. Scand J Rheumatol 1984;13:39–44. [CrossRef]
18. Wolfe F. Comparative usefulness of C-reactive protein and erythrocyte sedimentation rate in patients with rheumatoid arthritis. J Rheumatol 1997;24:1477–85.
19. Ward MM. Relative sensitivity to change of the erythrocyte sedimentation rate and serum C-reactive protein concentration in rheumatoid arthritis. J Rheumatol 2004;31:884–95.
20. Arvidson NG, Larsen A, Aaseth J, Larsson A. Short-term effects of the TNFalpha antagonist infliximab on the acute phase reaction and activities of daily life in patients with rheumatoid arthritis. Scand J Clin Lab Invest 2007;67:337–42. [CrossRef]