RESEARCH - ESR, CRP, or RF are normal at presentation in 35%-45% of patients with RA seen between 1980 and 2004

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J Rheumatol. 2009 May 1.

Erythrocyte Sedimentation Rate, C-Reactive Protein, or Rheumatoid

Factor Are Normal at Presentation in 35%-45% of Patients with

Rheumatoid Arthritis Seen Between 1980 and 2004: Analyses from Finland

and the United States.

Sokka T, Pincus T.

From Jyväskylä Central Hospital, Jyväskylä, Finland; and New York

University Hospital for Joint Diseases, New York, New York, USA.

OBJECTIVE: To analyze erythrocyte sedimentation rate (ESR), C-reactive

protein (CRP), and rheumatoid factor (RF) tests in 2 databases of

consecutive patients with rheumatoid arthritis (RA) over 25 years

between 1980 and 2004, in Finland and the USA.

METHODS: Databases of 1892 patients of 7 rheumatologists in Jyväskylä,

Finland, and 478 of one author in Nashville, TN, USA, seen in usual

care, were reviewed for the first recorded ESR and CRP, and all RF

tests.

RESULTS: Median ESR at presentation was 30 mm/h at both sites. Mean

ESR was 36 mm/h in Jyväskylä and 35 mm/h in Nashville. ESR was < 28

mm/h in 45% and 47% of patients at the 2 sites, respectively. CRP was

normal in 44% and 58%, and all RF tests were negative in 38% and 37%,

respectively. Both ESR and CRP were normal in 33% and 42% of patients,

and all 3 tests were normal in 15% and 14% of patients in whom they

were assessed. All 3 tests were abnormal in only 28% in Jyväskylä and

23% in Nashville.

CONCLUSION: A majority of patients with RA seen between 1980 and 2004

had abnormal ESR, CRP, or RF. However, more than 37% of patients had

ESR < 28 mm/h, normal CRP, or all negative RF tests. Similarities of

laboratory test data at 2 sites on different continents with different

duration of disease suggest generalizability of the findings. Normal

ESR, CRP, and RF are seen in a substantial proportion of patients with

RA at this time.

PMID: 19411389

http://www.ncbi.nlm.nih.gov/pubmed/19411389

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