Higher C-Reactive Protein Levels Signal Need for Early Intervention in Patients with Psoriatic Arthritis

JUNE 02, 2016
Andrew Smith
An observational study of psoriatic arthritis patients indicated that initial levels of C-reactive protein are correlated with a poor response to disease modifying anti-rheumatic drugs (DMARDs) and the eventual need for treatment with tumor necrosis factor-alpha inhibitors (anti-TNFs).
Investigators followed 71 consecutive patients who were diagnosed with psoriatic arthritis and tried to differentiate patients who did and did not respond to DMARDs.
Physicians started 81.6% of the newly diagnosed patients on methotrexate and started all the rest on some other DMARD. Follow-up visits showed that 37 of the 71 patients (52.11%) had an inadequate response to DMARDs, which, in turn, led to the use of at least on anti-TNF medication.
Investigators then compared outcomes with baseline information about each patient and found that initial levels of C-reactive protein were correlated with the eventual need for anti-TNF drugs (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.27–1.85; p = 0.009). Patients with baseline levels of C-reactive protein > 0.9 mg/dl, moreover, started anti-TNF treatment significantly earlier than other patients who started on such treatments.
“There are, as yet, no known clinical or laboratory parameters to identify patients at high risk of an inadequate response to a [non-steroidal anti-inflammatory drug] and/or DMARD, who would then require biological therapy with a TNF inhibitor,” the study authors wrote in the Isreal Medical Association Journal.
“The present long-term, single-center, observational study of a ‘real life’ inception cohort shows for the first time that elevated C-reactive protein level at diagnosis is significantly predictive of earlier need for treatment with a TNFα inhibitor drug to control disease activity in psoriatic arthritis.”

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