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© 1993 British Society for Rheumatology

The Acute-Phase Response in Relation to Radiographic Progression in Early Rheumatoid Arthritis: A Prospective Study During the First Three Years of the Disease

M. A. van Leeuwen*, M. H. van Rijswijk*, D. M. F. M. van der Heijde{dagger}, G. J. Te Meerman{ddagger}, P. L. C. M. van Riel{dagger}, P. M. Houtman§, L. B. A. van de Putte{dagger} and P. C. Limburg*

* Department of Rheumatology, University Hospital Groningen
{dagger} Department of Rheumatology, University Hospital Nijmegen
{ddagger} Institute of Medical Genetics, University of Groningen Groningen
§ Department of Rheumatology, Medical Centre Leeuwarden, The Netherlands

Correspondence to: Correspondence to M. H. van Rijswijk, Academic Hospital Groningen, Department for Internal Medicine, PO Box 30.001, 9700 RB Groningen, The Netherlands.


  Abstract

Studies on the relationship between acute-phase protein (APP) production, clinical disease activity and progression of radiological damage in RA have been hampered by three factors: patients are studied at different stages of the disease; APP levels are taken incidentally rather than serially; and inter-individual differences in the relationship between the extent of the acute-phase reaction and the progression of radiological damage are not accounted for. A group of 110 newly diagnosed (complaints >1 year) patients with RA were analysed for a follow-up period of at least three years. Damage was assessed radiologically according to the modified method of Sharp. As radiological progression is a cumulative event, APP production was also calculated by plotting serial CRP levels over time. Overall, a highly significant correlation was found between CRP production and radiological progression; however, a wide variation was observed due to inter-individual differences. The greatest variation was found in the lower range of CRP values, where inter-individual variation could not be accounted for by HLA-DR4, positive RF, sex or age. In conclusion, the prognostic use of serial measurement of APPs for the assessment of radiological progression is limited due to inter-individual variation. Knowledge of the factors under–lying these inter-individual differences will increase the applicability of CRP in the prediction of joint damage for individ–ual patients.

KEY WORDS: Acute-phase proteins, Radiological analysis, Early rheumatoid arthritis, C-reactive protein, Therapeutic response


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