Alberdi-Saugstrup Mikel, Zak Marek, Nielsen Susan, Herlin Troels, Nordal Ellen, Berntson Lillemor, Fasth Anders, Rygg Marite
Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark.
Department of Pediatrics, Naestved Hospital, Region Zealand, Denmark.
Rheumatol Int. 2017 May;37(5):695-703. doi: 10.1007/s00296-017-3657-x. Epub 2017 Mar 10.
To evaluate whether C-reactive protein (CRP), including variation within the normal range, is predictive of long-term disease outcome in Juvenile Idiopathic Arthritis (JIA). Consecutive patients with newly diagnosed JIA were included prospectively from defined geographic areas of the Nordic countries from 1997 to 2000. Inclusion criteria were availability of a baseline serum sample within 12 months after disease onset and 8-year clinical assessment data. Systemic onset JIA was not included. CRP was measured by high-sensitive ELISA (detection limit of 0.2 mg/l). One hundred and thirty participants with a median follow-up time of 97 months (range 95-100) were included. At follow-up, 38% of the patients were in remission off medication. Absence of remission was associated with elevated level of CRP at baseline (odds ratio (OR) 1.33, confidence interval (CI) 1.08-1.63, p = 0.007). By applying a cutoff at the normal upper limit (>10 mg/l), the risk of not achieving remission was increased to an OR of 8.60 (CI 2.98-24.81, p < 0.001). Variations of CRP within the normal range had no predictive impact on disease activity at follow-up. Baseline levels of ESR were available in 80 patients (61%) and elevated ESR was associated with absence of remission in a multivariable logistic regression analysis (OR 2.32, CI 1.35-4.00, p = 0.002). This results of this study indicate that baseline CRP concentrations above 10 mg/l are predictive of a poor outcome at 8-year follow-up. We could not demonstrate any predictive value of CRP variations within the normal range.
评估包括正常范围内变化的C反应蛋白（CRP）是否可预测幼年特发性关节炎（JIA）的长期疾病转归。1997年至2000年，从北欧特定地理区域前瞻性纳入新诊断JIA的连续患者。纳入标准为疾病发作后12个月内有基线血清样本以及8年临床评估数据。不包括全身型JIA。采用高敏ELISA法检测CRP（检测限为0.2mg/l）。纳入130名参与者，中位随访时间为97个月（范围95 - 100个月）。随访时，38%的患者停药缓解。未缓解与基线时CRP水平升高相关（比值比（OR）1.33，置信区间（CI）1.08 - 1.63，p = 0.007）。通过将临界值设定为正常上限（>10mg/l），未实现缓解的风险增加至OR为8.60（CI 2.98 - 24.81，p < 0.001）。正常范围内CRP的变化对随访时的疾病活动无预测影响。80名患者（61%）有血沉（ESR）基线水平，在多变量逻辑回归分析中，ESR升高与未缓解相关（OR 2.32，CI 1.35 - 4.00，p = 0.002）。本研究结果表明，基线CRP浓度高于10mg/l可预测8年随访时的不良转归。我们未能证明正常范围内CRP变化的任何预测价值。
