活动性银屑病关节炎患者的C反应蛋白正常：来自真实世界临床实践的结果
Normal C-reactive protein in active psoriatic arthritis: results from real-world clinical practice.
作者信息
Gialouri Chrysoula G, Evangelatos Gerasimos, Pappa Maria, Karamanakos Anastasios, Iliopoulos Alexios, Tektonidou Maria G, Sfikakis Petros P, Fragoulis George E
机构信息
Joint Academic Rheumatology Program, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Rheumatology Department, 417 Army Shared Fund Hospital NIMTS, Athens, Greece.
出版信息
Ther Adv Musculoskelet Dis. 2022 Sep 5;14:1759720X221122417. doi: 10.1177/1759720X221122417. eCollection 2022.
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%, = 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), = 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.
背景
银屑病关节炎（PsA）中正常C反应蛋白（CRP）的价值存在争议。
目的
检验这一假设，即在当代现实世界的PsA患者中，尽管疾病处于活动期，但CRP通常正常。
设计
在这项横断面研究中，患者被分为两组：CRP≤0.5mg/dl（正常）和CRP>0.5mg/dl（升高）。以CRP状态作为因变量，比较这两组患者的疾病相关特征，包括综合疾病活动指数[银屑病关节炎临床疾病活动度（cDAPSA）和最小疾病活动度（MDA）]以及患者报告结局（PROs）。计算CRP状态与cDAPSA/MDA评分之间的一致性（Cohen's kappa）。
方法
分析了在两家门诊风湿病诊所就诊的连续PsA患者的数据（2019年1月至2021年6月）。
结果
在纳入的128例患者中（女性占51.6%；平均±标准差年龄：53.4±11.7岁；分别有23.4%、48.4%和64.1%的患者接受糖皮质激素、传统合成改善病情抗风湿药物（csDMARDs）和生物DMARDs治疗），三分之二（66.4%，n = 85）患者的CRP值正常。CRP状态与任何疾病相关参数和PROs均无关联，但仅与血沉相关[比值比：1.04（95%置信区间：1.01 - 1.06），P = 0.005]。在CRP正常的患者中，45.9%（39/85）处于非MDA状态，而21.2%（18/85）的患者cDAPSA为中度，5.9%（5/85）的患者cDAPSA为高度疾病活动度。相反，处于非MDA状态的患者中有54.2%（39/72）以及cDAPSA为中度或高度疾病活动度的患者中有52.3%（23/44）的CRP值正常。正常CRP与MDA、cDAPSA缓解以及cDAPSA缓解/低疾病活动度之间的Cohen's kappa分别为 - 0.26、 - 0.21和 - 0.22，显示完全不一致。
结论
PsA中正常CRP不应用作缓解或低/MDA的替代标志物，因此在临床决策中需要谨慎解读。
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