van Leeuwen M A, van Rijswijk M H, Sluiter W J, van Riel P L, Kuper I H, van de Putte L B, Pepys M B, Limburg P C
Department of Rheumatology, University Hospital, Groningen, The Netherlands.
J Rheumatol. 1997 Jan;24(1):20-7.
Evaluation of the individual relationship between C-reactive protein (CRP) production or erythrocyte sedimentation rate (ESR) and progression of radiologic damage in early rheumatoid arthritis (RA), to improve the predictive value of monitoring the acute phase response.
The relationship was modeled mathematically using adjustments for discontinuity in the radiographic scoring system and for clustering in the occurrence of score points in the initial phase. The model was evaluated in a prospective study of 149 patients with early RA, monthly CRP assays, and 6-monthly Sharp scores of radiographs of the hands and feet.
Time integrated CRP values correlated closely with radiologic progression in each patient, but there was considerable variation between individuals with similar radiographic scores. The theoretical model accommodated these results, and based on CRP measurements and radiographic scores over 6 months, it provided a k value for each patient that reflected the individual relationship between CRP and radiologic damage. Using this k value combined with actual CRP levels over 3 and 6 years, the model accurately predicted the extent of radiologic progression that was actually observed at these times. Best results were obtained using estimation of the k value from 6 or 12 month observational data. The model has been incorporated into a software program for routine clinical use that indicates the levels to which CRP should fall to prevent further joint damage. Similar results were obtained for ESR.
A model has been established defining the individual relationship between time integrated CRP and ESR values, reflecting rheumatoid disease activity, and progression of radiologic damage. It accurately prediets outcome from 6 months after presentation and can be used as a practical decision support system.
评估C反应蛋白（CRP）产生或红细胞沉降率（ESR）与早期类风湿关节炎（RA）放射学损伤进展之间的个体关系，以提高监测急性期反应的预测价值。
利用放射学评分系统中的不连续性调整以及初始阶段评分点出现的聚类情况，对该关系进行数学建模。在一项对149例早期RA患者的前瞻性研究中评估该模型，对患者进行每月一次的CRP检测，并每6个月对手足X线片进行Sharp评分。
每位患者的时间积分CRP值与放射学进展密切相关，但在具有相似放射学评分的个体之间存在相当大的差异。理论模型符合这些结果，并且基于6个月内的CRP测量值和放射学评分，为每位患者提供了一个k值，该值反映了CRP与放射学损伤之间的个体关系。使用该k值结合3年和6年期间的实际CRP水平，该模型准确预测了在这些时间实际观察到的放射学进展程度。使用6个月或12个月观察数据估计k值可获得最佳结果。该模型已被纳入一个用于常规临床使用的软件程序，该程序可指示CRP应降至何种水平以防止进一步的关节损伤。ESR也得到了类似的结果。
已建立一个模型，该模型定义了时间积分CRP和ESR值之间的个体关系，反映类风湿疾病活动以及放射学损伤的进展。它能准确预测发病6个月后的结果，可作为一个实用的决策支持系统。
