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Meta-Analysis
. 2023 Sep;42(9):2397-2407.
doi: 10.1007/s10067-023-06658-w. Epub 2023 Jun 19.

The correlations between C-reactive protein and MRI-detected inflammation in patients with axial spondyloarthritis: a systematic review and meta-analysis

Haoran Tian #  1 , Ting Li #  1 , Yuanqiong Wang  1 , Hongjuan Lu  1 , Li Lin  1 , Xin Wu  1 , Huji Xu  2   3   4
Affiliations
Meta-Analysis

The correlations between C-reactive protein and MRI-detected inflammation in patients with axial spondyloarthritis: a systematic review and meta-analysis

Haoran Tian et al. Clin Rheumatol. 2023 Sep.

Abstract

Background: C-reactive protein (CRP) and magnetic resonance imaging (MRI) are widely used to monitor inflammation in patients with axial spondyloarthritis (axSpA), but the relationship between CRP and MRI-detected inflammation is incompletely understood. The present study was undertaken to assess correlations between CRP and MRI-detected inflammation in axSpA.

Materials and methods: A systematic literature search was performed (Medline, Embase, and Cochrane Library) to identify relevant studies concerning CRP and MRI-detected inflammation in axSpA patients. The MRI-detected inflammation was evaluated by MRI-based disease activity score (DAS). The correlation between CRP and MRI-based DAS was integrated by random-effect models.

Results: Eighteen studies reported a total of 1392 axSpA patients which were included in this meta-analysis. CRP was significantly associated with spinal MR DAS (r=0.226, 95%CI [0.149, 0.291], p<0.001, I2=23%). We also found a moderate correlation between CRP change and spinal MR DAS change (r[ASspiMRI-a]=0.354, 95%CI [0.282, 0.422], p<0.001, I2=48%; r[SPARCC]=0.544, 95%CI [0.345, 0.701], p<0.001, I2=19%). CRP at baseline was negatively associated with improvement in spinal MR DAS (r= - 0.327, 95%CI [-0.397, -0.264], p<0.001, I2=0%). However, no significant association was found between CRP and sacroiliac joint (SIJ) MR DAS.

Conclusions: In axSpA patients, CRP is associated with MRI-detected inflammation in the spine but not in SIJ. We speculate that CRP could be a reasonable index to reflect spinal inflammation. Therefore, we suggest it is not essential to repeat spinal MRI in a short term, while SIJ MRI may be necessary to provide additional information on inflammation. Key Points • CRP is associated with MRI-detected inflammation in the spine but not in sacroiliac joints. • CRP at baseline was negatively associated with improvement in spinal MR DAS. • It was not essential to repeat spinal MRI frequently, while SIJ MRI may be necessary to provide additional information on inflammation.

Keywords: Axial spondyloarthritis; C-reactive protein; Disease activity; Magnetic resonance imaging.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flow chart describing the systematic search and study selection
Fig. 2
Fig. 2
A Correlation between CRP and MR DAS. B Correlation between baseline CRP and MR DAS change. C Subgroup correlation between baseline CRP and MR DAS change
Fig. 3
Fig. 3
A Correlation between CRP change and MR DAS change (spine). B Correlation between CRP change and MR DAS change (SIJ)
See this image and copyright information in PMC

References

    1. Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet (London, England) 2017;390(10089):73–84. doi: 10.1016/S0140-6736(16)31591-4. - DOI - PubMed
    1. van der Heijde D, Ramiro S, Landewé R, Baraliakos X, Van den Bosch F, Sepriano A, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017;76(6):978–991. doi: 10.1136/annrheumdis-2016-210770. - DOI - PubMed
    1. Benhamou M, Gossec L, Dougados M. Clinical relevance of C-reactive protein in ankylosing spondylitis and evaluation of the NSAIDs/coxibs’ treatment effect on C-reactive protein. Rheumatology (Oxford, England) 2010;49(3):536–541. doi: 10.1093/rheumatology/kep393. - DOI - PubMed
    1. Mandl P, Navarro-Compán V, Terslev L, Aegerter P, van der Heijde D, D’Agostino MA, et al. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis. 2015;74(7):1327–1339. doi: 10.1136/annrheumdis-2014-206971. - DOI - PubMed
    1. Baraliakos X, Szumski A, Koenig AS, Jones H. The role of C-reactive protein as a predictor of treatment response in patients with ankylosing spondylitis. Semin Arthritis Rheum. 2019;48(6):997–1004. doi: 10.1016/j.semarthrit.2018.10.019. - DOI - PubMed

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