Which Measure of Inflammation to Use? A Comparison of Erythrocyte Sedimentation Rate & C-Reactive Protein Measurements

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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

http://www.jrheum.org/content/early/2009/06/15/jrheum.081188.abstract?papetoc

Address correspondence to Dr. E.L. Matteson, Division of Rheumatology, Mayo

Clinic, 200 First St. SW, Rochester, MN 55905. E-mail:

matteson.eric@...

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.

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 with each other. DAS-ESR and DAS-CRP were highly correlated

with each other, although DAS-ESR values were slightly lower than the

DAS-CRP values at the upper end of the range. Both ESR and CRP were

significantly associated with CDAI .

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.