Effects of disease-modifying anti-rheumatic drugs, steroids and non-steroidal anti-inflammatory drugs on acute-phase proteins in rheumatoid arthritis.

Elevated serum concentrations of acute-phase proteins (APPs) are a characteristic finding of rheumatic diseases, including RA. CRP is the most useful measure of disease activity and is frequently assessed in clinical trials to determine systemic improvement. The effects of different therapies for RA on CRP have been assessed in many studies. The DMARDs such as gold salts, D-penicillamine, sulphasalazine and azathioprine have been shown to reduce serum CRP concentrations significantly in patients with RA. CRP serum concentration is also reduced by the corticosteroids such as prednisone, but addition of pulse therapy with i.v. methylprednisolone had no additive effect compared with DMARDs alone. Many studies have shown that serum CRP concentrations are not reduced by NSAIDs; however, one recent study has demonstrated that CRP concentration was reduced by the NSAIDs flurbiprofen and sustained-release ibuprofen in a subgroup of patients.