Relative sensitivity to change of the sed ate and serum CRP concentration in RA

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J Rheumatol. 2004 May;31(5):884-95.

Relative sensitivity to change of the erythrocyte sedimentation rate and

serum C-reactive protein concentration in rheumatoid arthritis.

Ward MM.

Intramural Research Program, National Institute of Arthritis and

Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health

(NIH), US Department of Health and Human Services, Bethesda, land,

USA.

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.

PMID: 15124246

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