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. 2022 Jan 13;12(1):182.
doi: 10.3390/diagnostics12010182.

High Sensitivity C Reactive Protein in Patients with Rheumatoid Arthritis Treated with Antibodies against IL-6 or Jak Inhibitors: A Clinical and Ultrasonographic Study

Beatriz Frade-Sosa  1 , Andrés Ponce  1 , Virginia Ruiz-Esquide  1 , Maria Jesús García-Yébenes  2 , Rosa Morlá  1 , Nuria Sapena  1 , Julio Ramirez  1 , Ana Belen Azuaga  1 , Juan Camilo Sarmiento  1 , Juan D Cañete  1 , Jose A Gomez-Puerta  1 , Raimon Sanmarti  1
Affiliations

High Sensitivity C Reactive Protein in Patients with Rheumatoid Arthritis Treated with Antibodies against IL-6 or Jak Inhibitors: A Clinical and Ultrasonographic Study

Beatriz Frade-Sosa et al. Diagnostics (Basel). .

Abstract

Background: We examined whether high-sensitivity CRP (hsCRP) reflected the inflammatory disease status evaluated by clinical and ultrasound (US) parameters in RA patients receiving IL-6 receptor antibodies (anti-IL-6R) or JAK inhibitors (JAKi).

Methods: We conducted a cross-sectional study of patients with established RA receiving anti-IL-6R (tocilizumab, sarilumab) or JAKi (tofacitinib, baricitinib). Serum hsCRP and US synovitis in both hands were measured. Associations between hsCRP and clinical inflammatory activity were evaluated using composite activity indices. The association between hsCRP and US synovitis was analyzed.

Results: 63 (92% female) patients (42 anti- IL-6R and 21 JAKi) were included, and the median disease duration was 14.4 (0.2-37.5) years. Most patients were in remission or had low levels of disease. Overall hsCRP values were very low, and significantly lower in anti-IL-6R patients (median 0.04 mg/dL vs. 0.16 mg/dL). Anti-IL-6R (82.4%) patients and 48% of JAKi patients had very low hsCRP levels (≤0.1 mg/dL) (p = 0.002). In the anti-IL-6R group, hsCRP did not correlate with the composite activity index or US synovitis. In the JAKi group, hsCRP moderately correlated with US parameters (r = 0.5) but not clinical disease activity, and hsCRP levels were higher in patients with US synovitis (0.02 vs. 0.42 mg/dL) (p = 0.001).

Conclusion: In anti-IL-6R RA-treated patients, hsCRP does not reflect the inflammatory disease state, but in those treated with JAKi, hsCRP was associated with US synovitis.

Keywords: IL-6 inhibitor; JAK inhibitor; high-sensitivity C-reactive protein; rheumatoid arthritis; ultrasound synovitis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
hsCRP serum levels in patients classified according to the presence or absence of active ultrasound. (A) Patients receiving anti-IL-6R. (B) Patients receiving JAKi. Active US synovitis: SH grade ≥ 2 plus PD signal ≥ 1.
See this image and copyright information in PMC

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