Chrysoula G Gialouri, Gerasimos Evangelatos, Maria Pappa, Anastasios Karamanakos, Alexios Iliopoulos, Maria G Tektonidou, Petros P Sfikakis, George E Fragoulis
{"title":"活动性银屑病关节炎中的正常c反应蛋白:来自真实世界临床实践的结果。","authors":"Chrysoula G Gialouri, Gerasimos Evangelatos, Maria Pappa, Anastasios Karamanakos, Alexios Iliopoulos, Maria G Tektonidou, Petros P Sfikakis, George E Fragoulis","doi":"10.1177/1759720X221122417","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The value of normal C-reactive protein (CRP) in psoriatic arthritis (PsA) is debatable.</p><p><strong>Objectives: </strong>To test the hypothesis that CRP is frequently normal in contemporary real-world PsA patients, despite active disease.</p><p><strong>Design: </strong>In this cross-sectional study, patients were divided into two groups: CRP ⩽ 0.5 mg/dl (normal) and CRP > 0.5 mg/dl (increased). Having as dependent variable the CRP status, these groups were compared for disease-related features, including composite disease activity indices [clinical Disease Activity in PSoriatic Arthritis (cDAPSA) and minimal disease activity (MDA)] and patient-reported outcomes (PROs). Agreement between CRP status and cDAPSA/MDA scores was calculated (Cohen's kappa).</p><p><strong>Methods: </strong>Data from consecutive PsA patients attending two outpatient rheumatology clinics (January 2019-June 2021) were analysed.</p><p><strong>Results: </strong>From 128 patients enrolled (51.6% females; mean ± standard deviation age: 53.4 ± 11.7 years; 23.4%, 48.4% and 64.1% treated with glucocorticoids, conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biologic DMARDs, respectively), two-thirds (66.4%, <i>n</i> = 85) had normal CRP values. CRP status was not associated with any of the disease-related parameters and PROs, but only with ESR [odds ratio: 1.04 (95% confidence interval: 1.01-1.06), <i>p</i> = 0.005]. Among patients with normal CRP, 45.9% (39/85) were on non-MDA state, while 21.2% (18/85) had cDAPSA-moderate and 5.9% (5/85) had cDAPSA-high disease activities. Conversely, 54.2% (39/72) of patients on non-MDA state and 52.3% (23/44) of those with cDAPSA-moderate or cDAPSA-high disease activity had normal CRP values. Cohen's kappa between normal CRP and MDA, cDAPSA-remission, and cDAPSA-remission/low disease activity was -0.26, -0.21 and -0.22, respectively, displaying total disagreement.</p><p><strong>Conclusion: </strong>Normal CRP in PsA should not be used as surrogate marker of remission or low/MDA, therefore needs to be interpreted with caution in clinical decision-making.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d8/05/10.1177_1759720X221122417.PMC9445451.pdf","citationCount":"2","resultStr":"{\"title\":\"Normal C-reactive protein in active psoriatic arthritis: results from real-world clinical practice.\",\"authors\":\"Chrysoula G Gialouri, Gerasimos Evangelatos, Maria Pappa, Anastasios Karamanakos, Alexios Iliopoulos, Maria G Tektonidou, Petros P Sfikakis, George E Fragoulis\",\"doi\":\"10.1177/1759720X221122417\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The value of normal C-reactive protein (CRP) in psoriatic arthritis (PsA) is debatable.</p><p><strong>Objectives: </strong>To test the hypothesis that CRP is frequently normal in contemporary real-world PsA patients, despite active disease.</p><p><strong>Design: </strong>In this cross-sectional study, patients were divided into two groups: CRP ⩽ 0.5 mg/dl (normal) and CRP > 0.5 mg/dl (increased). Having as dependent variable the CRP status, these groups were compared for disease-related features, including composite disease activity indices [clinical Disease Activity in PSoriatic Arthritis (cDAPSA) and minimal disease activity (MDA)] and patient-reported outcomes (PROs). Agreement between CRP status and cDAPSA/MDA scores was calculated (Cohen's kappa).</p><p><strong>Methods: </strong>Data from consecutive PsA patients attending two outpatient rheumatology clinics (January 2019-June 2021) were analysed.</p><p><strong>Results: </strong>From 128 patients enrolled (51.6% females; mean ± standard deviation age: 53.4 ± 11.7 years; 23.4%, 48.4% and 64.1% treated with glucocorticoids, conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biologic DMARDs, respectively), two-thirds (66.4%, <i>n</i> = 85) had normal CRP values. CRP status was not associated with any of the disease-related parameters and PROs, but only with ESR [odds ratio: 1.04 (95% confidence interval: 1.01-1.06), <i>p</i> = 0.005]. Among patients with normal CRP, 45.9% (39/85) were on non-MDA state, while 21.2% (18/85) had cDAPSA-moderate and 5.9% (5/85) had cDAPSA-high disease activities. Conversely, 54.2% (39/72) of patients on non-MDA state and 52.3% (23/44) of those with cDAPSA-moderate or cDAPSA-high disease activity had normal CRP values. Cohen's kappa between normal CRP and MDA, cDAPSA-remission, and cDAPSA-remission/low disease activity was -0.26, -0.21 and -0.22, respectively, displaying total disagreement.</p><p><strong>Conclusion: </strong>Normal CRP in PsA should not be used as surrogate marker of remission or low/MDA, therefore needs to be interpreted with caution in clinical decision-making.</p>\",\"PeriodicalId\":23056,\"journal\":{\"name\":\"Therapeutic Advances in Musculoskeletal Disease\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2022-09-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d8/05/10.1177_1759720X221122417.PMC9445451.pdf\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Therapeutic Advances in Musculoskeletal Disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/1759720X221122417\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutic Advances in Musculoskeletal Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/1759720X221122417","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
Normal C-reactive protein in active psoriatic arthritis: results from real-world clinical practice.
Background: The value of normal C-reactive protein (CRP) in psoriatic arthritis (PsA) is debatable.
Objectives: To test the hypothesis that CRP is frequently normal in contemporary real-world PsA patients, despite active disease.
Design: In this cross-sectional study, patients were divided into two groups: CRP ⩽ 0.5 mg/dl (normal) and CRP > 0.5 mg/dl (increased). Having as dependent variable the CRP status, these groups were compared for disease-related features, including composite disease activity indices [clinical Disease Activity in PSoriatic Arthritis (cDAPSA) and minimal disease activity (MDA)] and patient-reported outcomes (PROs). Agreement between CRP status and cDAPSA/MDA scores was calculated (Cohen's kappa).
Methods: Data from consecutive PsA patients attending two outpatient rheumatology clinics (January 2019-June 2021) were analysed.
Results: From 128 patients enrolled (51.6% females; mean ± standard deviation age: 53.4 ± 11.7 years; 23.4%, 48.4% and 64.1% treated with glucocorticoids, conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biologic DMARDs, respectively), two-thirds (66.4%, n = 85) had normal CRP values. CRP status was not associated with any of the disease-related parameters and PROs, but only with ESR [odds ratio: 1.04 (95% confidence interval: 1.01-1.06), p = 0.005]. Among patients with normal CRP, 45.9% (39/85) were on non-MDA state, while 21.2% (18/85) had cDAPSA-moderate and 5.9% (5/85) had cDAPSA-high disease activities. Conversely, 54.2% (39/72) of patients on non-MDA state and 52.3% (23/44) of those with cDAPSA-moderate or cDAPSA-high disease activity had normal CRP values. Cohen's kappa between normal CRP and MDA, cDAPSA-remission, and cDAPSA-remission/low disease activity was -0.26, -0.21 and -0.22, respectively, displaying total disagreement.
Conclusion: Normal CRP in PsA should not be used as surrogate marker of remission or low/MDA, therefore needs to be interpreted with caution in clinical decision-making.
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