Clinical outcomes of patients with active rheumatoid arthritis with normal acute phase reactant values

Min Kyung Chung, Bohyun Park, In Je Kim, Soo-Kyung Cho, Dam Kim, Yoon-Kyoung Sung, Chan-Bum Choi, Jung Yoon Choe, Won Tae Chung, Seung Jae Hong, Tae-Hwan Kim, Eunmi Koh, Shin Seok Lee, Bo Young Yoon, Hyesook Park, Sang Cheol Bae, Jisoo Lee

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Aim: Despite high clinical disease activity, some patients with active rheumatoid arthritis (RA) have normal acute phase reactant (APR) values. This study aimed to determine the clinical outcomes of active RA patients with normal APR values. Method: Of 5376 patients with RA enrolled in the Korean observational study network for arthritis (KORONA) registry, 400 patients with disease duration of <2 years who had Clinical Disease Activity Index (CDAI) score of >2.8 at baseline, biologic-naïve, and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) drawn at both baseline and 2-year follow-up visits were identified. Patients were grouped according to baseline APR levels: normal APRs, one APR elevated, and both APRs elevated. Results: Baseline tender and swollen joint counts, mean CDAI and Health Assessment Questionnaire-Disability Index (HAQ-DI) scores were significantly lower in the normal APRs group compared with APR-elevated groups (P < 0.0001). At 2-year follow-up, mean CDAI scores, HAQ-DI, and percentage of the patient achieving remission were not significantly different between the normal APRs group compared with the APR-elevated groups regardless of the baseline disease activity. However, in patients with baseline CDAI moderate to high disease activity, the normal APRs group less frequently required initiation of the biologic disease-modifying anti-rheumatic drugs compared with the APR-elevated groups (P = 0.044). Conclusion: Active RA patients with normal APR values have milder disease presentation, but similar clinical outcomes to those with elevated APRs.

Original languageEnglish
Pages (from-to)852-859
Number of pages8
JournalInternational Journal of Rheumatic Diseases
Volume22
Issue number5
DOIs
StatePublished - 2019 May 1

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Acute-Phase Proteins
Rheumatoid Arthritis
Antirheumatic Agents
Blood Sedimentation
Health
Biological Products
C-Reactive Protein
Arthritis
Observational Studies
Registries
Joints

Keywords

  • active
  • acute-phase protein
  • normal
  • rheumatoid arthritis

Cite this

Chung, Min Kyung ; Park, Bohyun ; Kim, In Je ; Cho, Soo-Kyung ; Kim, Dam ; Sung, Yoon-Kyoung ; Choi, Chan-Bum ; Choe, Jung Yoon ; Chung, Won Tae ; Hong, Seung Jae ; Kim, Tae-Hwan ; Koh, Eunmi ; Lee, Shin Seok ; Yoon, Bo Young ; Park, Hyesook ; Bae, Sang Cheol ; Lee, Jisoo. / Clinical outcomes of patients with active rheumatoid arthritis with normal acute phase reactant values. In: International Journal of Rheumatic Diseases. 2019 ; Vol. 22, No. 5. pp. 852-859.
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title = "Clinical outcomes of patients with active rheumatoid arthritis with normal acute phase reactant values",
abstract = "Aim: Despite high clinical disease activity, some patients with active rheumatoid arthritis (RA) have normal acute phase reactant (APR) values. This study aimed to determine the clinical outcomes of active RA patients with normal APR values. Method: Of 5376 patients with RA enrolled in the Korean observational study network for arthritis (KORONA) registry, 400 patients with disease duration of <2 years who had Clinical Disease Activity Index (CDAI) score of >2.8 at baseline, biologic-na{\"i}ve, and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) drawn at both baseline and 2-year follow-up visits were identified. Patients were grouped according to baseline APR levels: normal APRs, one APR elevated, and both APRs elevated. Results: Baseline tender and swollen joint counts, mean CDAI and Health Assessment Questionnaire-Disability Index (HAQ-DI) scores were significantly lower in the normal APRs group compared with APR-elevated groups (P < 0.0001). At 2-year follow-up, mean CDAI scores, HAQ-DI, and percentage of the patient achieving remission were not significantly different between the normal APRs group compared with the APR-elevated groups regardless of the baseline disease activity. However, in patients with baseline CDAI moderate to high disease activity, the normal APRs group less frequently required initiation of the biologic disease-modifying anti-rheumatic drugs compared with the APR-elevated groups (P = 0.044). Conclusion: Active RA patients with normal APR values have milder disease presentation, but similar clinical outcomes to those with elevated APRs.",
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Clinical outcomes of patients with active rheumatoid arthritis with normal acute phase reactant values. / Chung, Min Kyung; Park, Bohyun; Kim, In Je; Cho, Soo-Kyung; Kim, Dam; Sung, Yoon-Kyoung; Choi, Chan-Bum; Choe, Jung Yoon; Chung, Won Tae; Hong, Seung Jae; Kim, Tae-Hwan; Koh, Eunmi; Lee, Shin Seok; Yoon, Bo Young; Park, Hyesook; Bae, Sang Cheol; Lee, Jisoo.

In: International Journal of Rheumatic Diseases, Vol. 22, No. 5, 01.05.2019, p. 852-859.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Clinical outcomes of patients with active rheumatoid arthritis with normal acute phase reactant values

AU - Chung, Min Kyung

AU - Park, Bohyun

AU - Kim, In Je

AU - Cho, Soo-Kyung

AU - Kim, Dam

AU - Sung, Yoon-Kyoung

AU - Choi, Chan-Bum

AU - Choe, Jung Yoon

AU - Chung, Won Tae

AU - Hong, Seung Jae

AU - Kim, Tae-Hwan

AU - Koh, Eunmi

AU - Lee, Shin Seok

AU - Yoon, Bo Young

AU - Park, Hyesook

AU - Bae, Sang Cheol

AU - Lee, Jisoo

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Aim: Despite high clinical disease activity, some patients with active rheumatoid arthritis (RA) have normal acute phase reactant (APR) values. This study aimed to determine the clinical outcomes of active RA patients with normal APR values. Method: Of 5376 patients with RA enrolled in the Korean observational study network for arthritis (KORONA) registry, 400 patients with disease duration of <2 years who had Clinical Disease Activity Index (CDAI) score of >2.8 at baseline, biologic-naïve, and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) drawn at both baseline and 2-year follow-up visits were identified. Patients were grouped according to baseline APR levels: normal APRs, one APR elevated, and both APRs elevated. Results: Baseline tender and swollen joint counts, mean CDAI and Health Assessment Questionnaire-Disability Index (HAQ-DI) scores were significantly lower in the normal APRs group compared with APR-elevated groups (P < 0.0001). At 2-year follow-up, mean CDAI scores, HAQ-DI, and percentage of the patient achieving remission were not significantly different between the normal APRs group compared with the APR-elevated groups regardless of the baseline disease activity. However, in patients with baseline CDAI moderate to high disease activity, the normal APRs group less frequently required initiation of the biologic disease-modifying anti-rheumatic drugs compared with the APR-elevated groups (P = 0.044). Conclusion: Active RA patients with normal APR values have milder disease presentation, but similar clinical outcomes to those with elevated APRs.

AB - Aim: Despite high clinical disease activity, some patients with active rheumatoid arthritis (RA) have normal acute phase reactant (APR) values. This study aimed to determine the clinical outcomes of active RA patients with normal APR values. Method: Of 5376 patients with RA enrolled in the Korean observational study network for arthritis (KORONA) registry, 400 patients with disease duration of <2 years who had Clinical Disease Activity Index (CDAI) score of >2.8 at baseline, biologic-naïve, and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) drawn at both baseline and 2-year follow-up visits were identified. Patients were grouped according to baseline APR levels: normal APRs, one APR elevated, and both APRs elevated. Results: Baseline tender and swollen joint counts, mean CDAI and Health Assessment Questionnaire-Disability Index (HAQ-DI) scores were significantly lower in the normal APRs group compared with APR-elevated groups (P < 0.0001). At 2-year follow-up, mean CDAI scores, HAQ-DI, and percentage of the patient achieving remission were not significantly different between the normal APRs group compared with the APR-elevated groups regardless of the baseline disease activity. However, in patients with baseline CDAI moderate to high disease activity, the normal APRs group less frequently required initiation of the biologic disease-modifying anti-rheumatic drugs compared with the APR-elevated groups (P = 0.044). Conclusion: Active RA patients with normal APR values have milder disease presentation, but similar clinical outcomes to those with elevated APRs.

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