Comparison of disease activity by disease activity score-28 C-reactive protein and disease activity score-28 erythrocyte sedimentation rate in established rheumatoid arthritis patients – A comparative study
DOI:
https://doi.org/10.55629/pakjpathol.v35i3.811Abstract
Objective. To compare disease activity in patients of established Rheumatoid Arthritis estimated by Disease Activity Score-28 (DAS-28) C-reactive protein (CRP) and Disease Activity Score-28 Erythrocyte Sedimentation Rate (ESR).
Material and Methods: This cross-sectional comparative study was conducted at Department of Rheumatology, Pak Emirates Military Hospital Rawalpindi, May 2022 to Oct 2022. Using consecutive non probability sampling, patients of Rheumatoid Arthritis (RA) of 30 to 65 years age of either gender were selected who had the disease for at least 1 year, never received biologics Disease modifying anti-rheumatic drugs (DMARDs) or immunosuppressive therapy and no signs of active infective etiology. DAS28 score was calculated using ESR and CRP to assess disease severity. Sensitivity, specificity, and agreement comparison was done between DAS28-ESR and DAS28-CRP and κ -coefficient was calculated with discordance proportion.
Results. Out of 70 patients, 50 (70%) were female and 20 (28%) were male with mean age of included patients 49.9 ± 7.5 years. Mean disease activity score, calculated using ESR was 4.1 ± 1.25 SD was higher than mean DAS28 score of 3.5 ± 1.12 SD with CRP. Twenty (28.6%) patients had High Disease Activity (HDA) (DAS28 > 5.1) when assessed by DAS28-ESR score as compared to 8 (11.4%) patients by DAS28-CRP score with 17.1% discordance and κ Coefficient of 0.402 corresponding to minimal agreement amid DAS28-ESR and DAS28-CRP for HDA (p < 0.005). DAS28 score using ESR as evaluating tool had 35% sensitivity and 98% specificity of detecting RA patients with High Disease Activity.
Conclusion. DAS28-ESR was preferable as compared to DAS28-CRP for monitoring disease activity and treatment decision.
Keywords. C-reactive protein (CRP), Disease activity score (DAS), Erythrocyte sedimentation rate (ESR), Joint pain, Rheumatoid arthritis, Visual analogue scale (VAS)
References
Weyand CM, Goronzy JJ. Immunometabolism in the development of rheumatoid arthritis. Immunol Rev. 2020; 294(1): 177–87.
DOI: https://doi.org/10.1111/imr.12838
Giannini D, Antonucci M, Petrelli F, Bilia S, Alunno A, Puxeddu I. One year in review 2020: Pathogenesis of rheumatoid arthritis. Clin Exp Rheumatol. 2020; 38(3): 387-97.
DOI:https://doi.org/10.55563/clinexprheumatol/3uj1ng
Littlejohn EA, Monrad SU. Early diagnosis and treatment of rheumatoid arthritis. Prim Care. 2018; 45(2): 237–55.
DOI: https://doi.org/10.1016/j.pop.2018.02.010
Curtis JR, Flake DD, Weinblatt ME, Shadick NA, Østergaard M, Hetland ML, et al. Adjustment of the multi-biomarker disease activity score to account for age, sex and adiposity in patients with rheumatoid arthritis. Rheumatology. 2019; 58(5): 874–83.
DOI: https://doi.org/10.1093/rheumatology/key367
Aletaha D, Smolen JS. Diagnosis and management of rheumatoid arthritis: A Review. JAMA. 2018; 320(13): 1360-72.
DOI: https://doi.org/10.1001/jama.2018.13103
Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020; 79(6): 685–99.
DOI: https://doi.org/10.1136/annrheumdis-2019-216655
Orr CK, Najm A, Young F, McGarry T, Biniecka M, Fearon U, et al. The utility and limitations of CRP, ESR and DAS28-CRP in appraising disease activity in rheumatoid arthritis. Front Med. 2018; 5: 185.
DOI: https://doi.org/10.3389/fmed.2018.00185
Son KM, Lee SY, Seo YI, Choi JE, Kim HA. Contribution of subjective disease activity score 28 (DAS28) components to the response to treatment of rheumatoid arthritis. Clin Rheumatol. 2017; 36(6): 1221–27. DOI: https://doi.org/10.1007/s10067-017-3628-3
Fleischmann RM, Van Der Heijde D, Gardiner PV, Szumski A, Marshall L, Bananis E. DAS28-CRP and DAS28-ESR cut-offs for high disease activity in rheumatoid arthritis are not interchangeable. RMD Open. 2017; 3(1): e000382.
DOI: https://doi.org/10.1136/rmdopen-2016-000382
Sengul I, Akcay-Yalbuzdag S, Ince B, Goksel-Karatepe A, Kaya T. Comparison of the DAS28-CRP and DAS28-ESR in patients with rheumatoid arthritis. Int J Rheum Dis. 2015; 18(6): 640–5.
DOI: https://doi.org/10.1111/1756-185x.12695
Dessein PH, Joffe BI, Stanwix AE, Christian BF, Veller M. Glucocorticoids and insulin sensitivity in rheumatoid arthritis. J Rheumatol. 2004; 31(5): 867–74.
Black RJ, Cross M, Haile LM, Culbreth GT, Steinmetz JD, Hagins H, et al. Global, regional, and national burden of rheumatoid arthritis, 1990–2020, and projections to 2050: A systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023; 5(10): e594–610.
DOI: https://doi.org/10.1016%2FS2665-9913(23)002 11-4
Alam SM, Kidwai AA, Jafri SR, Qureshi BM, Sami A, Qureshi HH, et al. Epidemiology of rheumatoid arthritis in a tertiary care unit, Karachi, Pakistan. J Pak Med Assoc. 2011; 61(2): 123–6.
Listing J, Kekow J, Manger B, Burmester GR, Pattloch D, Zink A, et al. Mortality in rheumatoid arthritis: the impact of disease activity, treatment with glucocorticoids, TNFα inhibitors and rituximab. Ann Rheum Dis. 2015; 74(2): 415–21.
DOI:https://doi.org/10.1136/annrheumdis-2013-2040 21
Greenmyer JR, Stacy JM, Sahmoun AE, Beal JR, Diri E. DAS28‐CRP cutoffs for high disease activity and remission are lower than DAS28‐ESR in rheumatoid arthritis. ACR Open Rheumatology. 2020; 2(9): 507–11.
DOI: https://doi.org/10.1002/acr2.11171
Nasir N, Majid H, Khan A, Awan S, Riaz M. Disease activity correlates and functionality in patients with rheumatoid arthritis – real-world experience from a South Asian country. Reumatologia. 2022; 60(3): 183–91. DOI:https://doi.org/10.5114/reum.2022.117838
Kuriya B, Xiong J, Boire G, Haraoui B, Hitchon C, Pope J, et al. Earlier time to remission predicts sustained clinical remission in early rheumatoid arthritis — results from the canadian early arthritis cohort (CATCH). J Rheumatol. 2014; 41(11): 2161–6. DOI: https://doi.org/10.3899/jrheum.140137
Shivacheva TK. DAS28-ESR and DAS28-CRP - are they Interchangeable in measuring the activity of rheumatoid arthritis in response to treatment with biological agents? Folia Med. 2020; 62(1): 46–51.
DOI: https://doi.org/10.3897/folmed.62.e47714
Pope JE, Choy EH. C-reactive protein and implications in rheumatoid arthritis and associated comorbidities. Semin Arthritis Rheum. 2021; 51(1): 219-29.
DOI: https://doi.org/10.1016/j.semarthrit.2020.11.005
Hamann PDH, Shaddick G, Hyrich K, Green A, McHugh N, Pauling JD, et al. Gender stratified adjustment of the DAS28-CRP improves inter-score agreement with the DAS28-ESR in rheumatoid arthritis. Rheumatol. 2019; 58(5): 831–5.
DOI: https://doi.org/10.1093/rheumatology/key374
Hensor EMA, Emery P, Bingham SJ, Conaghan PG, YEAR Consortium. Discrepancies in categorizing rheumatoid arthritis patients by DAS-28(ESR) and DAS-28(CRP): Can they be reduced? Rheumatol. 2010; 49(8): 1521–9.
DOI: https://doi.org/10.1093/rheumatology/keq117
Ranganath VK, Elashoff DA, Khanna D, Park G, Peter JB, Paulus HE, et al. Age adjustment corrects for apparent differences in erythrocyte sedimentation rate and C-reactive protein values at the onset of seropositive rheumatoid arthritis in younger and older patients. J Rheumatol. 2005; 32(6): 1040–2.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Amna Butt, Khalid Mehmood Raja, Fahad Javed Awan, Wajahat Ahmed Khan, Farhan zaid, Fahad Ul Hassan
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
