Haroon Muhammad, Gallaghar Phil, Ahmad Muddassar, FitzGerald Oliver
Department of Rheumatology, Fatima Memorial Hospital & FMH College of Medicine and Dentistry, Lahore, Pakistan.
Division of Rheumatology, University Hospital Kerry, Tralee, Ireland.
Clin Rheumatol. 2020 Oct;39(10):2951-2961. doi: 10.1007/s10067-020-05065-9. Epub 2020 Apr 2.
Little is known about the long-term association of CRP levels during psoriatic arthritis (PsA) disease course. In this study, we examined whether raised CRP over the disease course is associated with worse outcome measures in a well-characterised PsA cohort with a long-term follow up.
A cohort of 283 PsA patients (fulfilling CASPAR criteria) was evaluated. All underwent detailed skin and rheumatologic assessments. Moreover, we documented the presence/absence of comorbidities using Charlson Comorbidity Index (CCI). CRP at first visit to a rheumatologist was documented. Cumulative inflammation over time was represented by the cumulative averages of CRP (ca-CRP). Multiple linear regression modelling CRP was used.
Two hundred eighty-three PsA patients attended for detailed assessments. A total of 56.5% (n = 160) of the cohort had raised CRP at their first visit to our rheumatology department, and this was significantly associated with long-term erosions, sacroiliitis, PsA requiring TNFi, and high comorbidity Index, on logistic regression analysis. Moreover, 24% (n = 69) of the cohort never had raised CRP during their long-term follow-up, and on logistic regression analysis, such patients had significantly milder disease with fewer erosions, less sacroiliitis and fewer patients requiring TNFi therapy. The median (IQR) and mean (SD) Ca-CRP was 8.8 (4.6-14.8) and 11.72 (10.52), respectively. On multiple linear regression, erosions, sacroiliitis and CCI were most significantly associated with ca-CRP [(F = 77.6, p < 0.001), 72% (R-square)].
Elevated CRP is associated with radiographic damage, disease more resistant to treatment and also having higher number of significant comorbidities. Raised CRP can help stratify patients with a more severe PsA phenotype. Key Points • Raised CRP can provide important future prognostic information among patients with PsA. • PsA patients with raised CRP at first visit to a rheumatologist had significantly more destructive and refractory disease. • PsA patients with consistently normal CRP had significantly milder disease.
关于银屑病关节炎（PsA）病程中CRP水平的长期关联知之甚少。在本研究中，我们在一个经过充分特征描述且长期随访的PsA队列中，研究病程中CRP升高是否与更差的预后指标相关。
对一组283例PsA患者（符合CASPAR标准）进行评估。所有患者均接受了详细的皮肤和风湿病学评估。此外，我们使用Charlson合并症指数（CCI）记录了合并症的存在与否。记录了首次就诊于风湿病科时的CRP水平。CRP随时间的累积炎症由CRP的累积平均值（ca-CRP）表示。使用多元线性回归对CRP进行建模。
283例PsA患者接受了详细评估。该队列中共有56.5%（n = 160）的患者在首次就诊于我们的风湿病科时CRP升高，经逻辑回归分析，这与长期侵蚀、骶髂关节炎、需要使用肿瘤坏死因子抑制剂（TNFi）治疗的PsA以及高合并症指数显著相关。此外，该队列中有24%（n = 69）的患者在长期随访期间CRP从未升高，经逻辑回归分析，这类患者的疾病明显较轻，侵蚀较少，骶髂关节炎较少，需要TNFi治疗的患者也较少。Ca-CRP的中位数（IQR）和平均值（SD）分别为8.8（4.6 - 14.8）和11.72（±10.52）。经多元线性回归分析，侵蚀、骶髂关节炎和CCI与ca-CRP最显著相关[（F = 77.6，p < 0.001），决定系数（R平方）为72%]。
CRP升高与影像学损伤、对治疗更具抵抗性的疾病以及更多的显著合并症相关。CRP升高有助于对具有更严重PsA表型的患者进行分层。要点：• CRP升高可为PsA患者提供重要的未来预后信息。• 首次就诊于风湿病科时CRP升高的PsA患者具有明显更具破坏性和难治性的疾病。• CRP持续正常的PsA患者疾病明显较轻。
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