利用急性期反应物为更新的银屑病关节炎核心结局测量集的工具制定提供信息。
Using Acute-phase Reactants to Inform the Development of Instruments for the Updated Psoriatic Arthritis Core Outcome Measurement Set.
机构信息
From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto.
出版信息
J Rheumatol. 2019 Mar;46(3):266-273. doi: 10.3899/jrheum.180195. Epub 2018 Nov 1.
OBJECTIVE
Systemic inflammationˆ is assessed through measurement of acute-phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). With few exceptions, most randomized controlled trials (RCT) have assessed acute-phase reactants (CRP and ESR) as part of the American College of Rheumatology (ACR) 20 response criteria. As part of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-Outcome Measures in Rheumatology (OMERACT) working group, we performed a systematic review of the literature to assess the performance of inflammatory biomarkers in psoriatic arthritis (PsA).
METHODS
A systematic search of PubMed and Embase was performed. The search included peer-reviewed articles and scientific meeting abstracts about RCT and longitudinal observational studies that assessed systemic inflammation using acute-phase reactants in PsA. Studies were assessed following the components of the OMERACT filter including construct validity, responsiveness, and predictive validity.
RESULTS
There were 2764 articles retrieved, and 71 articles were included for this systematic review. Twenty-eight articles reported CRP and/or ESR separately, and the remaining articles reported CRP and/or ESR as part of the ACR response criteria. Studies assessing OMERACT responsiveness provided conflicting reports. Inflammatory biomarkers had construct validity for more active disease. Evidence suggests that an elevation of ESR predicts cardiovascular outcomes.
CONCLUSION
Data regarding assessment of systemic inflammation using acute-phase reactants (CRP and ESR) are limited. There is only weak evidence to support normalization of these biomarkers in predicting good clinical outcomes/remission criteria. The predictive value for cardiovascular outcomes was generally good. Further studies to assess systemic inflammation in PsA using acute-phase reactants and other laboratory biomarkers are needed.
目的
通过测量 C 反应蛋白（CRP）和红细胞沉降率（ESR）等急性期反应物来评估全身炎症。除了少数例外，大多数随机对照试验（RCT）都评估了急性期反应物（CRP 和 ESR），作为美国风湿病学会（ACR）20 反应标准的一部分。作为评估银屑病和银屑病关节炎（PsA）的疗效措施的 GRAPPA 工作组的一部分，我们对文献进行了系统回顾，以评估炎症生物标志物在 PsA 中的表现。
方法
对 PubMed 和 Embase 进行了系统搜索。搜索包括关于 RCT 和纵向观察研究的同行评议文章和科学会议摘要，这些研究使用 PsA 中的急性期反应物评估全身炎症。研究按照 OMERACT 过滤器的组成部分进行评估，包括结构有效性、反应性和预测有效性。
结果
共检索到 2764 篇文章，其中 71 篇文章被纳入本系统评价。28 篇文章分别报告了 CRP 和/或 ESR，其余文章报告了 CRP 和/或 ESR 作为 ACR 反应标准的一部分。评估 OMERACT 反应性的研究提供了相互矛盾的报告。炎症生物标志物对更活跃的疾病具有结构有效性。有证据表明，ESR 的升高预测心血管结局。
结论
使用急性期反应物（CRP 和 ESR）评估全身炎症的数据有限。只有微弱的证据支持这些生物标志物的正常化可预测良好的临床结局/缓解标准。对心血管结局的预测价值通常较好。需要进一步研究使用急性期反应物和其他实验室生物标志物评估 PsA 中的全身炎症。
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