Is there still a place for erythrocyte sedimentation rate and C-reactive protein in systemic lupus erythematosus?

Abstract

The inflammatory response during systemic lupus erythematosus (SLE) flares is known to be atypical, characterized by a disproportionately lower C-reactive protein (CRP) elevation when compared with erythrocyte sedimentation rate (ESR). Thus, in these patients, the analysis of inflammatory markers might be challenging in daily clinical practice. Clinicians need frequently to distinguish lupus reactivations and infectious conditions, and the significance of ESR and CRP seems to be different. Even though a non-specific marker of inflammation, ESR utility in SLE should not be neglected and it appears to be a useful biomarker for SLE activity assessment. Describing a specific cut-off for ESR in SLE is important for patients' follow-up, and levels up to 25-30 mm/h have been proposed as an upper limit of the normal range. Regarding CRP, even though higher baseline levels are described in SLE when compared with controls, including in remission periods, its response during flares seems to be incomplete and not always correlated with disease activity; while CRP values greater than 10 mg/l could be indicative for severe flares, when there is no serositis or arthritis, higher CRP levels above 50-60 mg/l may be associated with infection.

Serum osteopontin negatively impacts on intima‐media thickness in patients with systemic lupus erythematosus

“…However, clinical studies failed to clearly demonstrate hs‐CRP as a useful biomarker of CV risk in patients with SLE . Even, abnormally low levels of CRP have been observed in active SLE . This partial discrepancies as compared to the general population may be due to formation of anti‐CRP autoantibodies, as reported in about 35 to 40% of patients with SLE .…”

Mean Platelet Volume (MPV) as an indicator of disease activity and severity in lupus

“…Apart from MPV, ESR has traditionally been used as a marker of disease severity in patients with inflammatory conditions, and SLE, specifically 24 . Similarly, SLEDAI was promulgated in 1985 as a tool to assess disease activity in lupus.…”

“…SLEDAI-2000 has been validated against classic SLEDAI and is an important predictor of prognosis and mortality 26 . High disease activity will increase ESR and SLEDAI-2000 score 24, 26 . Our study demonstrated that, MPV correlated inversely with both ESR and SLEDAI-2000.…”

Molecular signatures in systemic lupus erythematosus: distinction between disease flare and infection

“…It is therefore possible that a composite measure comprised of an increased SLEDAI score, low C3 and expression of selected gene transcripts may improve the ability to rapidly distinguish SLE flare from infection in a clinical setting but this will rely on a larger validation study. Discordance between serum levels of C reactive protein (CRP) and erythrocyte sedimentation rate in disease flare is well recognised and elevated CRP has been reported as a surrogate marker for infection in patients with SLE in several studies (reviewed in 43 ). However, elevated CRP levels have been reported in patients with SLE with active arthritis, serositis and African heritage.…”