Shadick Nancy A, Cook Nancy R, Karlson Elizabeth W, Ridker Paul M, Maher Nancy E, Manson Joann E, Buring Julie E, Lee I-Min
Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Arch Intern Med. 2006;166(22):2490-4. doi: 10.1001/archinte.166.22.2490.
The purpose of this study was to examine whether levels of C-reactive protein (CRP), a sensitive marker of disease activity in rheumatoid arthritis (RA), are associated with increased risk of subsequent RA.
Eligible subjects were 39 876 healthy women from the Women's Health Study, a completed randomized trial of aspirin and vitamin E in cardiovascular disease and cancer prevention, begun in 1992. We included 27 939 women who provided blood samples at baseline that could be assayed for CRP.
During 9.9 years of follow-up, 398 women reported a new diagnosis of RA. Of these, 90 cases were confirmed on medical chart review using American College of Rheumatology criteria. In age-adjusted analysis, the relative risks for developing confirmed, incident RA associated with increasing tertiles of CRP (first, second, and third) were 1.00 (reference value), 0.94 (0.54-1.61), and 1.29 (0.78-2.12) (P = .30 for trend). Further adjustment for randomized treatment, age, body mass index, and smoking demonstrated corresponding relative risks of 1.00 (reference value), 0.95 (0.55-1.65), and 1.33 (0.77-2.30) (P = .48 for trend). When we examined whether CRP levels predicted incident RA within 4 years, between 5 to 8 years, and 9 or more years after CRP measurement, we found no significant associations for any time period.
In this prospective study of healthy women, a single CRP level did not predict increased risk of RA. Furthermore, CRP measurement closer to the time of diagnosis was not predictive. The consistency of this effect throughout different time periods from diagnosis suggests that CRP does not have a large effect in predicting incident RA.
本研究旨在探讨C反应蛋白（CRP）水平，一种类风湿关节炎（RA）疾病活动的敏感标志物，是否与后续发生RA的风险增加相关。
符合条件的受试者来自女性健康研究中的39876名健康女性，该研究是一项于1992年开始的关于阿司匹林和维生素E预防心血管疾病及癌症的已完成随机试验。我们纳入了27939名在基线时提供了可用于检测CRP的血样的女性。
在9.9年的随访期间，398名女性报告新诊断为RA。其中，90例经使用美国风湿病学会标准进行病历审查得以确诊。在年龄调整分析中，与CRP三分位数增加（第一、第二和第三）相关的确诊、新发RA的相对风险分别为1.00（参考值）、0.94（0.54 - 1.61）和1.29（0.78 - 2.12）（趋势P = 0.30）。对随机治疗、年龄、体重指数和吸烟进行进一步调整后，相应的相对风险分别为1.00（参考值）、0.95（0.55 - 1.65）和1.33（0.77 - 2.30）（趋势P = 0.48）。当我们检查CRP水平是否能预测在测量CRP后4年内、5至8年内以及9年或更久之后发生的新发RA时，我们发现在任何时间段均无显著关联。
在这项对健康女性的前瞻性研究中，单一的CRP水平并不能预测RA风险增加。此外，在更接近诊断时间测量CRP并无预测价值。从诊断开始的不同时间段内这种效应的一致性表明，CRP在预测新发RA方面没有很大作用。
