Elevated CRP even at the first visit to a rheumatologist is associated with long-term poor outcomes in patients with psoriatic arthritis, 2020, Haroon

Andy · Apr 4, 2020

Posting out of interest as we have seen ME studies on CRP as well.

Objectives
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.

Methods
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.

Results
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)].

Conclusions
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.
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Paywall, https://link.springer.com/article/10.1007/s10067-020-05065-9
Not available via Scihub at time of posting.

rvallee · Apr 4, 2020

also having higher number of significant comorbidities
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Looking forward to the details on that, especially what is meant by significant (meaning statistically or in terms of importance).

The belief that people can't possibly have so many symptoms and that this feature should always lead physicians towards psychosomatics is getting a beating from carefully looking at the evidence. Somehow it persists. How long can this ideology be maintained, especially as a positive clinical feature of "somatization"?

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Elevated CRP even at the first visit to a rheumatologist is associated with long-term poor outcomes in patients with psoriatic arthritis, 2020, Haroon

Andy Committee Member

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Elevated CRP even at the first visit to a rheumatologist is associated with long-term poor outcomes in patients with psoriatic arthritis, 2020, Haroon

Andy Committee Member

rvallee Senior Member (Voting Rights)

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