Rheumatoid Arthritis: Treatment Which Controls the C-Reactive Protein and Erythrocyte Sedimentation Rate Reduces Radiological Progression

Abstract

One hundred and fifty consecutive patients with active, rheumatoid arthritis were assessed and treated with gold, D-penicillamine, chloroquine or dapsone. Four groups were selected from these patients. Group I consisted of 60 patients who did not complete 12 months' therapy. Group II consisted of patients in whom ESR and C-reactive protein (CRP) fell to less than 30 mm/h and less than 20 mg/l, respectively, and remained at these levels between 6 and 12 months. In group IV the ESR and CRP fell but remained greater than 30 and greater than 20, respectively, during the same period. Group III patients had variable ESRs and CRPs between 6 and 12 months. In groups II, III and IV there was a significant deterioration (p less than 0.01) in the hand and foot radiographs from 0 to 6 months. Between 6 and 12 months the radiographs in groups III and IV continued to show significant radiological progression (p less than 0.01), but those of group II did not alter. These results suggest radiological deterioration continues during the first 6 months regardless of clinical response but thereafter, further deterioration is less likely to occur when the ESR and CRP are consistently controlled.

Predictors of joint damage in patients with early rheumatoid arthritis treated with high‐dose methotrexate with or without concomitant infliximab: Results from the ASPIRE trial

“…Patients treated with MTX alone in this study also showed increasing progression of joint damage with increasing time-averaged disease activity, as reflected in the levels of acute-phase reactants and swollen joint counts. These findings are consistent with those of previous studies in which normalization of disease activity during the course of therapy was an important factor in preventing major radiographic progression (7,13,17,18). However, even in patients with persistently elevated disease activity, the use of infliximab along with optimal doses of MTX therapy significantly retarded progression of radiographic changes.…”

“…These relationships have been established from previous studies of the natural course of RA and from results of clinical trials of treatments that are no longer the standard of care (14)(15)(16). Nevertheless, it is well known that disease-modifying antirheumatic drug (DMARD) therapy can successfully interfere with disease progression and that such efficacy is particularly evident in patients with a well-controlled acute-phase response (13,17,18).…”

Serum Calprotectin Versus Acute‐Phase Reactants in the Discrimination of Inflammatory Disease Activity in Rheumatoid Arthritis Patients Receiving Tumor Necrosis Factor Inhibitors

“…In general, the reduction in CRP and ESR levels correlate with a decrease in clinical disease activity (32) and less joint destruction (33), although this may be due, in part, to the direct systemic effect of TNFi on hepatic synthesis of acute-phase proteins rather than a true improvement in local synovitis. In fact, CRP level is an important biomarker of radiographic progression in RA patients receiving DMARDs (methotrexate), but this predictive value disappears when RA patients are treated with TNFi (34).…”

The diagnosis and prognosis of early arthritis: Rationale for new prognostic criteria

“…It is widely believed that an elevated acute-phase response, especially a high CRP level, predicts subsequent radiologic damage (12). Van Leeuwen and colleagues (13) showed, in a prospective study of 149 patients with early RA, that in individual patients, time-integrated CRP values correlated closely with radiologic progression.…”