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4, 2004 423
Kadir Yildirim, Saliha Karatay, Meltem Alkan Melikoglu, Gurhan Gureser, Mahir Ugur, Kazm Senel
Department of Physical Medicine and Rehabilitation, Atatrk University Medical School, Erzurum, Turkey
Abstract. Serum levels of acute phase reactants (APR) were measured in patients with rheumatoid arthritis
(RA) and the correlations of these parameters with the disease activity score (DAS28) were investigated.
The study included 47 patients with RA and 50 healthy controls. Laboratory tests included erythrocyte
sedimentation rate (ESR), serum C-reactive protein (CRP), haptoglobin (Hp), ferritin, and plasma fibrinogen.
Disease activity was assessed using the DAS28 score. The means ( SD) of ESR, CRP, Hp, ferritin, and
fibrinogen levels were respectively 36.0 23.5 mm/hr, 2.4 1.9 mg/dl, 121.3 34.2 mg/dl, 67.7 36.2
ng/ml, and 371.2 96.0 mg/dl in the patients with RA, vs 16.4 11.3 mm/hr, 0.4 0.3 mg/dl, 104.0
35.3 mg/dl, 50.9 23 ng/ml, and 332.2 58.5 mg/dl in the controls. All of the APR levels were significantly
higher in patients vs controls (p <0.001 for ESR and CRP; p <0.05 for Hp, ferritin, and fibrinogen). There
were significant correlations between serum APR levels and disease activity based on DAS28 score in RA
patients (for CRP, r = 0.650, p <0.01; for Hp, r = 0.331, p <0.05; for ferritin, r = 0.299, p <0.05; for
fibrinogen, r = 0.373, p <0.01). This study indicates that serum CRP, among the various ARP tests, is the
most useful biochemical marker for evaluating the disease activity of patients with RA. (received 20 August 2004;
accepted 25 August 2004).
Keywords: rheumatoid arthritis, DAS28 score, acute phase reactants, C-reactive protein
importance as a coagulation protein, is also an APR The DAS28 score (DAS28/ESR) was calculated
and its plasma concentration is increased in diseases according to Prevoo et al [9].
involving tissue damage or inflammation [8]. Blood ESR was determined by the Westergren
The DAS28 score is used extensively to evaluate method and serum CRP by nephelometry using the
disease activity in patients with rheumatoid arthritis Array Protein System (Beckman Coulter, Inc).
(RA). DAS28 is a composite index that provides Serum Hp level was assayed with a commercial kit
clinicians with a simple and objective assessment of by a nephelometric method (Beckman Coulter
the patients level of disease activity and progression Image). Serum ferritin level was measured by an
[9]. The aim of this study was to investigate the automatic analyzer system (E170 Modular System,
correlations between DAS28 score and the various Roche Diagnostics). Plasma fibrinogen level was
APR levels in RA patients and to determine which determined with a commercial kit using an
of the acute phase reactants shows the closest autoanalyzer (Dade-Behring Corp).
relationship to the disease activity. Statistical analyses of data were performed with
the SPSS program. Laboratory results were given as
Material and Methods mean SD. Differences between groups were
evaluated by the Mann-Whitney U test. Correlation
This study involved patients with RA diagnosed between variables was assessed by Spearmans rank
according to the 1987 revised criteria of the correlation coefficient. P values <0.05 were regarded
American College of Rheumatology (formerly, the as significant.
American Rheumatism Association) [10]. Clinical
assessments included demographic data: age, sex, Results
weight, and duration of disease. In the patient group
(n = 47), there were 40 women and 7 men (mean Demographic data for the 47 RA patients and 50
age 45.7 9.5 yr; range 24-66). The mean disease control subjects are listed in Table 1. There were no
duration was 10.8 4.4 yr (range 3-24). In the significant differences between the 2 groups with
control group (n = 50), there were 45 women and 5 respect to parameters such as age, gender, or body
men (mean age 44.9 8.8 yr, range, 27-63). The weight (p >0.05).
controls were healthy hospital personnel without any Laboratory findings in the RA patients and
history of inflammatory diseases. No patient was healthy controls are listed in Table 2. The mean levels
receiving glucocorticoids or immunosuppressant of ESR, CRP, Hp, ferritin, and fibrinogen in RA
drugs, such as cyclosporine or levamisole. At the time patients were all significantly higher than in healthy
of the study, 27 patients were treated with a comb- controls (for ESR and CRP, p <0.001; for Hp,
ination of methotrexate and sulfasalazyn; 20 patients ferritin, and fibrinogen, p <0.05).
were receiving only methotrexate. All patients were Strongly positive correlation was noted between
being treated with nonsteroidal anti-inflammatory the DAS28 score and serum CRP level (r = 0.650, p
drugs. The patients were allowed to continue their <0.001) in RA patients (Fig. 1). There were also
drug regimens. Patients were excluded if they had significant correlations between the DAS28 score
signs or symptoms of severe renal, hepatic, endocrine
(Pagets disease, hyper-thyroidism, hyperpara- Table 1. Demographic properties of the patients with RA and
thyroidism), hematological, lymphoproliferative, healthy controls (mean SD).
and other malignant diseases. The exclusion criteria
Characteristic RA group Controls p value
for the control group were the same as for the RA
group. Number (M/F) n = 47 (7/40) n = 50 (5/45) ns
The DAS28 score is the numerical sum of 4 Age (yr) 45.7 9.5 44.9 8.8 ns
outcome parameters: tender and swollen joint count Body weight (kg) 66.1 7.3 67.3 8.3 ns
Disease duration (yr) 10.8 4.4 - -
(based on a 28-joint assessment), patients global
assessment, visual analogue scale, and ESR value. ns: not a statistically significant difference.
[23,24]. None of our RA patients were pregnant or 12. Mackiewicz A, Speroff T, Ganapathi MK, et al. Effect of
used oral contraceptives, so their elevated plasma cytokine combinations on acute phase protein production
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14. Yildirim K, Erdal A, Karatay S, Melikoglu MA, Ugur M,
RA patients.
Senel K. Relationship between some acute phase reactants
and the Bath Ankylosing Spondylitis Disease Activity
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