Comparative usefulness of C-reactive protein and erythrocyte sedimentation rate in juvenile rheumatoid arthritis

OBJECTIVE: To compare serial C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels in juvenile rheumatoid arthritis (JRA) patients and investigate their application as diagnostic parameters and prognostic predictive factors. METHODS: We carried out retrospective chart review among JRA patients who were followed-up at the National Taiwan University Hospital (NTUH) between 1994 and 2005. RESULTS: Thirty-nine girls and 68 boys were included in this study. At the time of diagnosis, the prevalence of ESR was significantly greater than that of CRP (86.8% vs. 47.2%, p < 0.05). ESR revealed more responsiveness to treatment compared to CRP (SRMs were -0.69 and -0.31, respectively). At the time of diagnosis, high CRP levels (>or= 5mg/dL) correlated with poor therapeutic response, as do positive CRP (> 0.8 mg/dL) and high ESR levels (> 40 mm/h) after treatment for six months. Overall, initial high CRP levels (>or= 5mg/dL) demonstrated the strongest predictive role of failure of the first remission. CONCLUSION: For disease diagnosis, ESR can be a better parameter than CRP but a high initial CRP level can strongly predict treatment failure of the first remission.     

Relationship between erythrocyte sedimentation rate and serum C-reactive protein in rheumatoid arthritis.

Serum C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were compared in 241 patients with rheumatoid arthritis (RA). There was a positive linear correlation between the 2 measurements with a high degree of variability. Neither age nor duration of RA had a detectable influence. The relationship between CRP and ESR was, however, altered by treatment with gold, penicillamine, or high doses of prednisone. It is suggested that serum CRP is the more sensitive measurement, but that CRP and ESR do not have identical clinical significance.     

Relative sensitivity to change of the erythrocyte sedimentation rate and serum C-reactive protein concentration in rheumatoid arthritis

OBJECTIVE: To compare the sensitivity to change of the erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) concentration used as measures of rheumatoid arthritis (RA) activity. METHODS: A literature search was conducted to identify all clinical trials and observational studies of disease-modifying medications and corticosteroids in RA that reported results for both ESR and CRP before treatment and 4 weeks to 24 weeks after treatment in the same patients. For each test, effect sizes were computed as the change in the test with treatment divided by the pretreatment standard deviation. A pooled analysis was performed on the paired differences in effect sizes for ESR and CRP within each study. RESULTS: One hundred twenty-three studies with 184 active treatment arms were identified that included measurements of both ESR and CRP. Sixty-three studies with 90 active treatment arms provided sufficient data to permit calculation of effect sizes, and were included in the analysis. In the 36 treatment arms that reported results at 12 weeks, the ESR was more sensitive to change than the CRP, with a paired difference in effect sizes of 0.09 units (95% confidence interval 0.03, 0.15; p = 0.005). In the 76 treatment arms that reported results at 24 weeks, the ESR was also more sensitive to change than the CRP, with a paired difference in effect sizes of 0.11 units (95% CI 0.05, 0.17; p = 0.0004). CONCLUSION: In these studies of disease-modifying medications in RA, the ESR was more sensitive to change than the CRP at 12 weeks and 24 weeks of treatment. Few studies examined changes in these measures at times earlier than 12 weeks.     

Raised erythrocyte sedimentation rate signals heart failure in patients with rheumatoid arthritis

BACKGROUND: Inflammatory markers are associated with heart failure. Patients with rheumatoid arthritis have twice the risk of heart failure compared with people without rheumatoid arthritis. OBJECTIVE: To assess whether heart failure in patients with rheumatoid arthritis is preceded by an inflammatory activation as shown by erythrocyte sedimentation rate (ESR), a systemic marker of inflammation. METHODS: A population-based inception cohort of 575 patients with rheumatoid arthritis, free of heart failure at their rheumatoid arthritis incidence date, was followed up longitudinally until death or 2001. During 15 years of follow-up, they had a median of 15 ESR tests, and 172 patients had new-onset heart failure (Framingham Heart Study criteria). The follow-up period, beginning with the rheumatoid arthritis incidence date and ending with date of the last follow-up, was divided into 6-month intervals. The proportions of patients with at least one ESR value >/=40 mm/h and with anaemia (haemoglobin <11 g/dl) within each 6-month interval were plotted against time from fulfilment of heart failure criteria. A binomial test was used to compare proportions. RESULTS: In patients with rheumatoid arthritis who developed heart failure, the proportion with ESR >/=40 mm/h was highest (23%) during the 6-month period immediately preceding the new-onset heart failure, as compared with the average ESR during the entire remaining follow-up period, both before and after heart failure (10.6%; p<0.01). The proportion of patients with anaemia peaked (54%) during the 6-month period after heart failure. CONCLUSIONS: Inflammatory stimuli may be involved in the initiation of heart failure among patients with rheumatoid arthritis.     

Effects of gold, dapsone, and prednisone on serum C-reactive protein and haptoglobin and the erythrocyte sedimentation rate in rheumatoid arthritis.

Sequential measurements of serum C-reactive protein (CRP), serum haptoglobin (Hp), and erythrocyte sedimentation rate (ESR) were made in 209 patients with rheumatoid arthritis (RA); 78 of them were treated with gold, 71 with dapsone, and 60 with prednisone. The results were expressed as proportional changes in the measurements at 28-day intervals after treatment began. The period of study was 140 days. During treatment with gold and dapsone there were statistically significant gradual and progressive falls of similar magnitude in serum CRP and ESR. During treatment with prednisone serum CRP and ESR fell abruptly by 28 days and thereafter altered little. At 140 days prednisone had had the largest proportional effect on both measurements. During gold treatment the fall in serum Hp was similar to that of the ESR. In contrast, prednisone had little effect on Hp levels despite large falls in serum CRP and the ESR. Either prednisone stimulates Hp synthesis or the divergence is an expression of the difference in type of effect between gold and prednisone on RA. The effect of dapsone on serum Hp was large and progressive; it partly reflects haemolysis and, since the haemolysis was not progressive, partly improvement in the RA. The results show the relative efficacy of the drugs and suggest that dapsone may be a useful alternative treatment for RA.     

A comparison of the erythrocyte sedimentation rate and serum C-reactive protein concentration in elderly patients

Fifty-five consecutive admissions to an acute geriatric unit were studied prospectively. Individuals were classified according to the obvious presence or absence of an active disease process on admission and their serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured then and five days later. There was no significant difference between the ESR values in the two groups either on admission or at day 5, nor was there any significant change between admission and day 5. In contrast, CRP values were very significantly higher in the active than in the non-active group and there were marked changes over the 5-day period corresponding to changes in clinical condition. These results indicate that the serum CRP concentration is superior to the ESR as an objective, non-specific marker for disease activity in the elderly.     

C-反应蛋白与血沉在老年肺部感染中的临床应用价值研究

目的 探讨C-反应蛋白(C-reactive protein,CRP)与血沉(erythrocyte sedimentation rate,ESR)在老年肺部感染中的临床应用价值.方法 老年肺部感染500例,所有病例均在人院的第1天、第3天、第5天、第7天、第14天清晨采静脉血测定CRP、ESR和白细胞计数(WBC).同时对患者入院当天进行临床肺部感染评分(clinical pulmonary infection score,CPIS).结果①经有效治疗后各数值较治疗前均明显下降(P<0.01);②血清CRP较ESR下降迅速(P<0.01);③CRP阳性率明显高于ESR和wBc(P<0.01);④经两参数的相关性分析.CRP、ESR与CPIS均相关,相关程度CRP>ESR.结论 血清CRP与ESR均为临床老年肺部感染诊断和治疗评价的有效指标.CRP有助于老年肺部感染的早期识别及感染严重程度的判定,并且能够迅速准确地反映抗生素的疗效,是明显优于ESR、WBC等的有效炎症指标.     

High-sensitivity C-reactive protein and erythrocyte sedimentation rate in systemic lupus erythematosus

Levels of C-reactive protein (CRP) have been shown to rise in acute illnesses such as infections and some autoimmune diseases, but not in flares of systemic lupus erythematosus (SLE). Our goal was to investigate the high-sensitivity CRP (hsCRP) response to infection versus disease flare in patients with SLE, and to compare this with the erythrocyte sedimentation rate (ESR) response in these patients. We aimed to determine the hsCRP level that distinguishes between infection and flare in SLE, and investigated the correlation between hsCRP and organ involvement in SLE. We reviewed electronic medical records of all patients with SLE admitted to Cedars Sinai Medical Center between 28 August 2001 and 27 April 2008. Patients were divided into three groups based on the reason for hospitalization: (1) lupus flare; (2) active infection; and (3) both lupus flare and active infection. Data were collected on patient demographics, medication use, microbial culture results, organ involvement in lupus flare, ESR and CRP levels. Data were collected on 85 eligible patients, of whom 54 had a lupus flare, 22 had active infection and eight had both. While the ESR levels did not differ significantly between patients with disease flare and active infection, the hsCRP level was significantly lower in the lupus flare group than in the infection group. Most patients in the lupus flare group who had a significantly high hsCRP level had serositis. We found that at a cut-off of above 5?mg/dl, hsCRP level was correlated with infection with a specificity of 80%. At a cut-off of above 6?mg/dl, hsCRP correlated with infection with a specificity of 84%. hsCRP level was found to be significantly higher in patients with pulmonary involvement than without. hsCRP levels are significantly lower in SLE patients with disease flare than in those with active infection. Elevated hsCRP levels can be used as a predictor of active infection in SLE patients with a high specificity. We review the relationship between IL-6 and hsCRP production in lupus patients.     

Activated T lymphocytes,rheumatoid factor and erythrocyte sedimentation rate assays in rheumatoid arthritis

Summary Activated T lymphocytes (Ia⁺ T-cells) in peripheral blood are associated with immune stimulation. We found the percentages of these cells significantly increased in 95% of rheumatoid arthritis (RA) patients. Our studies showed no relation between the percentages of these cells in peripheral blood and concurrent erythrocyte sedimentation rates or rheumatoid factor titers. Circulating immune complex titers determined in a small number of patients conjectured an association with Ia⁺ T-cell levels.     

Changes in erythrocyte sedimentation rate, C-reactive protein and hematological parameters in patients with acute malaria

Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and routine hematological parameters were reviewed in 258 patients with acute malaria and compared to a control group of 120 patients with other febrile illnesses after visiting malaria endemic areas. Thrombocytopenia was found in 80% of the malaria patients compared to 13% in controls (p less than 0.01). The malaria patients also had lower white blood cell counts and marginally lower hemoglobin values than control patients. No major differences were found in ESR or CRP values. Furthermore, there were no major differences in the hematological parameters between patients infected with different malaria species, or between patients with different ethnic background. Thrombocytopenia (platelet count less than 150 x 10(9)/l) had a predictive value positive of 56% and a predictive value negative of 95% for malaria in a febrile patient coming from an endemic area. Thus, the risk of malaria in a febrile thrombocytopenic patient coming from an endemic area was 56%, while the risk that another patient with a normal platelet count still had malaria was 5%.     

Impact of the size and number of swollen joints on serum C-reactive protein level and erythrocyte sedimentation rate in rheumatoid arthritis: a cross-sectional study in Japan

Clinical Rheumatology - No studies have yet reported the influence of swelling in individual joints on serum C-reactive protein and erythrocyte sedimentation rate. To examine this association, we...     

血清降钙素原、C-反应蛋白和血沉联合检测在老年肺炎中的临床价值

目的探讨血清降钙素原（PCT）、C-反应蛋白（CRP）和血沉（ESR）在老年肺炎诊断、预后及疗效评价中的临床价值。方法对62例老年肺炎患者及52例健康老年人PCT、CRP、ESR检查指标进行比较。结果与对照组相比肺炎患者三项指标均明显升高,有显著性差异（P〈0．05）。PCT、CRP、ESR的诊断敏感性分别为90．3％、83．9％、80．6％,敏感性无统计学意义。PCT特异性为98．4％,显著高于CRP、ESR的特异性（79．0％、74．2％）,有显著差异性。结论血清PCT、CRP、ESR的测定对老年肺炎有一定诊断价值,特别是PCT水平可以作为早期诊断老年肺炎的重要指标。