Dataset Information

Normal C-reactive protein in active psoriatic arthritis: results from real-world clinical practice.

ABSTRACT:

Background

The value of normal C-reactive protein (CRP) in psoriatic arthritis (PsA) is debatable.

Objectives

To test the hypothesis that CRP is frequently normal in contemporary real-world PsA patients, despite active disease.

Design

In this cross-sectional study, patients were divided into two groups: CRP ⩽ 0.5 mg/dl (normal) and CRP > 0.5 mg/dl (increased). Having as dependent variable the CRP status, these groups were compared for disease-related features, including composite disease activity indices [clinical Disease Activity in PSoriatic Arthritis (cDAPSA) and minimal disease activity (MDA)] and patient-reported outcomes (PROs). Agreement between CRP status and cDAPSA/MDA scores was calculated (Cohen's kappa).

Methods

Data from consecutive PsA patients attending two outpatient rheumatology clinics (January 2019-June 2021) were analysed.

Results

From 128 patients enrolled (51.6% females; mean ± standard deviation age: 53.4 ± 11.7 years; 23.4%, 48.4% and 64.1% treated with glucocorticoids, conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biologic DMARDs, respectively), two-thirds (66.4%, n = 85) had normal CRP values. CRP status was not associated with any of the disease-related parameters and PROs, but only with ESR [odds ratio: 1.04 (95% confidence interval: 1.01-1.06), p = 0.005]. Among patients with normal CRP, 45.9% (39/85) were on non-MDA state, while 21.2% (18/85) had cDAPSA-moderate and 5.9% (5/85) had cDAPSA-high disease activities. Conversely, 54.2% (39/72) of patients on non-MDA state and 52.3% (23/44) of those with cDAPSA-moderate or cDAPSA-high disease activity had normal CRP values. Cohen's kappa between normal CRP and MDA, cDAPSA-remission, and cDAPSA-remission/low disease activity was -0.26, -0.21 and -0.22, respectively, displaying total disagreement.

Conclusion

Normal CRP in PsA should not be used as surrogate marker of remission or low/MDA, therefore needs to be interpreted with caution in clinical decision-making.

SUBMITTER: Gialouri CG

PROVIDER: S-EPMC9445451 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

Normal C-reactive protein in active psoriatic arthritis: results from real-world clinical practice.

Gialouri Chrysoula G CG Evangelatos Gerasimos G Pappa Maria M Karamanakos Anastasios A Iliopoulos Alexios A Tektonidou Maria G MG Sfikakis Petros P PP Fragoulis George E GE

Therapeutic advances in musculoskeletal disease 20220905

<h4>Background</h4>The value of normal C-reactive protein (CRP) in psoriatic arthritis (PsA) is debatable.<h4>Objectives</h4>To test the hypothesis that CRP is frequently normal in contemporary real-world PsA patients, despite active disease.<h4>Design</h4>In this cross-sectional study, patients were divided into two groups: CRP ⩽ 0.5 mg/dl (normal) and CRP > 0.5 mg/dl (increased). Having as dependent variable the CRP status, these groups were compared for disease-related features, including com ...[more]

PMID: 36081746

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Project description:BackgroundPsoriatic arthritis (PsA) is a chronic, immune-mediated, spondyloarthropathy characterised by musculoskeletal signs and symptoms with associated joint pain and tenderness. The average worldwide PsA prevalence is 133/100,000, while in the Italian population is 90-420/100,000. Traditionally, nonsteroidal anti-inflammatory drugs, glucocorticoid, and disease-modifying antirheumatic drugs have been used in the treatment of PsA. However, for those patients who are not adequately controlled with conventional therapies, the new biologics compounds represent a valid option. Biologic therapies have been shown to be more effective but also more expensive than conventional systemic treatments. Based on the CHRONOS study, the economic analyses presented in this paper aim to assess the annualised direct costs and the cost-per-responder of biologics in a real-world context assuming the Italian National Health System perspective.MethodsThe economic assessments were carried out on the overall cohort of patients, and on the tumour necrosis factor alpha inhibitors (TNFi) and the secukinumab subgroup, the most prescribed biologic therapies within the CHRONOS study.ResultsThe annual economic impact of PsA in the overall group was €12,622, €11,725 in the secukinumab subgroup, and €12,791 in the TNFi subgroup. Biologics absorbed the main expenditure costs in the treatment of PsA accounting for about the 93% of total costs. At 6 months, secukinumab performed better in all the considered outcomes: cost-per-responder according to EULAR DAS28 and ACR50 response criteria were €12,661- €28,975, respectively, while they were €13,356 - €33,368 in the overall cohort and €13,138 - €35,166 in the TNFi subgroup. At 12 months secukinumab remained the subgroup with the lowest cost-per-responder ratio in EULAR DAS28 and ACR50 response criteria, while TNFi subgroup was the lowest one considered the ACR20.ConclusionDespite some potential methodological limitations, our cost-per-response analysis provides physicians and payers additional insights which can complement the traditional risk-benefit profile assessment and drive treatment decisions.

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Dataset Information

Normal C-reactive protein in active psoriatic arthritis: results from real-world clinical practice.

Background

Objectives

Design

Methods

Results

Conclusion

Publications

Normal C-reactive protein in active psoriatic arthritis: results from real-world clinical practice.

Similar Datasets

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