RESEARCH - Which measure of inflammation to use? A comparison of ESR and CRP in golimumab trials

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J Rheumatol. 2009 Jun 16.

Which Measure of Inflammation to Use? A Comparison of Erythrocyte

Sedimentation Rate and C-Reactive Protein Measurements from Randomized

Clinical Trials of Golimumab in Rheumatoid Arthritis.

Crowson CS, Rahman MU, Matteson EL.

From the Division of Biomedical Statistics and Informatics, Department

of Health Sciences Research, and Division of Rheumatology, Mayo

Clinic, Rochester, Minnesota; Centocor Research and Development, Inc.,

Malvern, Pennsylvania; and Division of Rheumatology, University of

Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.

OBJECTIVE: To assess clinical utility of measurements of C-reactive

protein (CRP) versus Westergren erythrocyte sedimentation rate (ESR)

in evaluating patients with rheumatoid arthritis (RA).

METHODS: Data from 3 randomized clinical trials of golimumab involving

1247 patients with RA in which ESR and CRP were obtained at baseline

and Week 24, along with standard measures of clinical disease activity

[swollen and tender joint counts, global disease activity assessment,

composite Disease Activity Scores (DAS) and Clinical Disease Activity

Index(CDAI)], were utilized.

RESULTS: Both ESR and CRP were significant predictors of swollen joint

count (p< 0.001 for each). Only 4.5% of patients with no swollen

joints had elevated CRP and normal ESR, but 15.2% had elevated ESR and

normal CRP. ESR and CRP correlated significantly (Pearson r =0.59, p <

0.001) with each other. DAS-ESR and DAS-CRP were highly correlated (r

= 0.96, p< 0.001) with each other, although DAS-ESR values were

slightly lower than the DAS-CRP values at the upper end of the range

(DAS > 8). Both ESR and CRP were significantly associated with CDAI (p

< 0.001 for each).

CONCLUSION: It is not necessary to obtain both ESR and CRP measures

for clinical disease activity assessment in clinical trials of RA.

Neither test adds significantly to clinical measures of disease

activity including joint counts and global assessments. Where

available, the CRP alone may be preferred for disease activity

assessment as a simple, validated, reproducible, non age-dependent

test.

PMID: 19531760

http://www.ncbi.nlm.nih.gov/pubmed/19531760

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