LABORATORY RESULTS THAT SUGGEST USING PROGNOSTIC MARKERS IN ASSESSMENT AND DIAGNOSIS OF RHEUMATOID ARTHRITIS

  • Dejan Spasovski University Clinic for Rheumatology, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R. North Macedonia
  • Emilija Sandevska University Clinic for Rheumatology, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R. North Macedonia
  • Aleksandra Pivkova Veljanovska University Clinic of Hematology, Clinical Center “Mother Theresa”, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R.North Macedonia
  • Svetlana Krstevska Balkanov University Clinic of Hematology, Clinical Center “Mother Theresa”, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R.North Macedonia

Abstract

ESR and CRP reactants reflect synovitis indirectly. Simultaneously, they are the cause of objectivization and measurement of immune-mediated inflammatory responses in RA. CRP, RF, and ESR testing accompanied with clinical variables of inflammatory synovitis are suggested to evaluate the disease’s activity. Aim: Assessment of RA’s activity with the reactants of the acute phase, ESR, CRP, and RF as prognostic markers for disease activity in patients treated with Methotrexate for early RA. This study focuses on 70 patients in total: 35 patients with early RA and 35 patients in the healthy control group. Patients (pts) were given Methotrexate once a week at a dose of 10 mg on average. We were able to analyze ESR, RF, and CRP in every patient at certain time intervals (0 times, after 6, 9, and 12 months). RA was assessed following the dynamics of changes in the mean values of CRP, RF, and ESR. The analysis showed statistically notable differences among the mean values of ESR in the four-time intervals (p=0,00002). The mean values of CRP also showed differences in all four-time intervals (p=0,0428). On the other hand, no noteworthy statistical differences were detected among the mean values of RF in the four-time intervals (p=0,573). High values of CRP and RF were detected in most patients. The process of disease progression continues despite the Methotrexate therapy, especially in those patients that have elevated values of ESR, CRP, and RF. They are shown to be predictors of the aggressive course of the disease. This enables the selection of the high-risk group of patients for an aggressive course of the disease and points to the necessity for early and aggressive treatment.


Keywords: RA (Rheumatoid Arthritis); RF (Rheumatoid Factor); reactants of the acute phase; CRP.


https://doi.org/10.55302/JMS2251157s

References

1. Kuper IH, Van Leeuwen MA, Van Riel PLCM, Sluiter WJ, Houtman NM, Cats HA, VanRijswijk MH. Influence of a ceiling effect on the assessment of radiographic progression in rheumatoid arthritis during the first 6 years of the disease. J Rheumatol 1999; 26:268-76.
2. Belghomari H, Saraux A, Allain J, Guedes C, Youinou P, Goff PL. Risk factors for radiographic articular destruction of hands and wrists in rheumatoid arthritis. J Rheumatol 1999; 26: 2534-8.
3. Molenaar ETH, Edmonds J, Boers M, van der Heijde DMFN, Lassere M. A practical exercise in reading RA radiographs by the Larsen and Sharp methods. J Rheumatol 1999; 26: 746-8.
4. Guillemin F, Billot L, Boini S, Gerard N, Odegaard S, Kvien TK. Reproducibility and sensitivity to change of 5 methods for scoring hand radiographic damage in patients with rheumatoid arthritis. J Rheumatol 2005; 32: 778-86.
5. Plant MJ, Williams AL, O' Sullivan MM, Lewis PA, Coles EC, Jessop JD. Relationship between time-integrated c-reactive protein levels and radiologic progression in patients with rheumatoid arthritis. Arthritis Rheum 2000; 43(7): 1473-7.
6. Kirwan JR. The relationship between synovitis and erosions in rheumatoid arthritis. Br J Rheumatol 1997; 36: 225-228.
7. Strand V, Sharp JT Radiographic data from recent randomized controlled trials in rheumatoid arthritis. Arthritis Rheum 2003; 48: 21-34.
8. Visser H, le Cessie S, Vos K, Breedveld FC, Hazes J. How to diagnose rheumatoid arthritis early: a prediction model for persistent( erosive) arthritis. Arthritis rheum 2002; 46: 357-65.
9. Redlich K, Hayer S, Ricci R. Osteoclasts are essential for TNF-a-mediated joint destruction. J Clin Invest 2002; 110:1419-27.
10. James R. O'Dell. Therapeutic strategies for rheumatoid arthritis. N Engl J Med 2004; 350:2591-2602.
11. Hoekstra M,van Ede AE, Haagsma CJ. Factors associated with toxicity, final dose, and efficacy of methotrexate in patients with rheumatoid arthritis. Ann Rheum Dis 2003; 62: 423-6.
12. Jansen LMA, van der Horst - Bruinsma IE, van Schaardenburg D, Bezemer PD, Dijkmans BAC. Predictors of radiographic joint damage in patients with early rheumatoid arthritis. Ann Rheum Dis 2001; 60: 924-027.
13. Ten Klooster PM, Versteeg LGA, Oude Voshaar MAH, de la Torre I, De Leonardis F, Fakhouri W, et all Radiographic progression can still occur in individual patients with low or moderate disease activity in the current treat-to-target paradigm: real-world data from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. Arthritis Res Ther. 2019;21(1): 237.
14. Darrah E, Yu F, Cappelli LC, Rosen A, O'Dell JR, Mikuls TR. Association of Baseline Peptidylarginine Deiminase 4 Autoantibodies With Favorable Response to Treatment Escalation in Rheumatoid Arthritis. Arthritis Rheumatol. 2019;71(5):696-702.
15. Fautrel B, Nab HW, Brault Y, Gallo G. Identifying patients with rheumatoid arthritis with moderate disease activity at risk of significant radiographic progression despite methotrexate treatment. RMD Open. 2015; 1(1): e000018.
16. Edwards CJ, Kiely P, Arthanari S, Kiri S, Mount J, Barry J, et all. Predicting disease progression and poor outcomes in patients with moderately active rheumatoid arthritis: a systematic review. Rheumatol Adv Pract. 2019; 3(1): rkz002.
17. Boeters DM, Nieuwenhuis WP, Verheul MK, Newsum EC, Reijnierse M, Toes RE, Trouw LA, van der Helm-van Mil AH.MRI-detected osteitis is not associated with the presence or level of ACPA alone, but with the combined presence of ACPA and RF..Arthritis Res Ther. 2016;18:179.
18. Lykke Midtboll. Structural damage and hand bone loss in patients with rheumatoid arthritis Dan Med J 2018;65(3): B5452.
19. Azzouzi H, Ichchou L.Bone Loss and Radiographic Damage Profile in Rheumatoid Arthritis Moroccan Patients. J Bone Metab. 2021;28(2):151-9.
20. Joo YB, Bang SY, Ryu JA, et al. Predictors of severe radiographic progression in patients with early rheumatoid arthritis: A Prospective observational cohort study. Int J Rheum Dis. 2017;20:1437–46.
21. Iwata T, Ito H, Furu M, et al. Periarticular osteoporosis of the forearm correlated with joint destruction and functional impairment in patients with rheumatoid arthritis. Osteoporos Int. 2016;27:691–701.
22. Mochizuki T, Yano K, Ikari K, et al. Correlation between hand bone mineral density and joint destruction in established rheumatoid arthritis. J Orthop. 2017;14:461–5.
23. Compston J. Glucocorticoid-induced osteoporosis: an update. Endocrine. 2018;61:7–16.
24. Heinze G, Wallisch C, Dunkler D. Variable selection - A review and recommendations for the practising statistician. Biom J. 2018;60:431–49.
25. Wehmeyer C, Pap T, Buckley CD, et al. The role of stromal cells in inflammatory bone loss. Clin Exp Immunol. 2017;189:1–11.
Published
2022-05-04
How to Cite
SPASOVSKI, Dejan et al. LABORATORY RESULTS THAT SUGGEST USING PROGNOSTIC MARKERS IN ASSESSMENT AND DIAGNOSIS OF RHEUMATOID ARTHRITIS. Journal of Morphological Sciences, [S.l.], v. 5, n. 1, p. 157-162, may 2022. ISSN 2545-4706. Available at: <http://jms.mk/jms/article/view/vol5no1-21>. Date accessed: 25 june 2022.
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Articles