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How age and sex affect the erythrocyte sedimentation rate and C-reactive protein in early rheumatoid arthritis

BACKGROUND: The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are two commonly used measures of inflammation in rheumatoid arthritis (RA). As current RA treatment guidelines strongly emphasize early and aggressive treatment aiming at fast remission, optimal measurement of inflamm...

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Autores principales: Siemons, Liseth, ten Klooster, Peter M, Vonkeman, Harald E, van Riel, Piet LCM, Glas, Cees AW, van de Laar, Mart AFJ
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4228188/
https://www.ncbi.nlm.nih.gov/pubmed/25373740
http://dx.doi.org/10.1186/1471-2474-15-368
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author Siemons, Liseth
ten Klooster, Peter M
Vonkeman, Harald E
van Riel, Piet LCM
Glas, Cees AW
van de Laar, Mart AFJ
author_facet Siemons, Liseth
ten Klooster, Peter M
Vonkeman, Harald E
van Riel, Piet LCM
Glas, Cees AW
van de Laar, Mart AFJ
author_sort Siemons, Liseth
collection PubMed
description BACKGROUND: The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are two commonly used measures of inflammation in rheumatoid arthritis (RA). As current RA treatment guidelines strongly emphasize early and aggressive treatment aiming at fast remission, optimal measurement of inflammation becomes increasingly important. Dependencies with age, sex, and body mass index have been shown for both inflammatory markers, yet it remains unclear which inflammatory marker is affected least by these effects in patients with early RA. METHODS: Baseline data from 589 patients from the DREAM registry were used for analyses. Associations between the inflammatory markers and age, sex, and BMI were evaluated first using univariate linear regression analyses. Next, it was tested whether these associations were independent of a patient’s current disease activity as well as of each other using multiple linear regression analyses with backward elimination. The strengths of the associations were compared using standardized beta (β) coefficients. The multivariate analyses were repeated after 1 year. RESULTS: At baseline, both the ESR and CRP were univariately associated with age, sex, and BMI, although the association with BMI disappeared in multivariate analyses. ESR and CRP levels significantly increased with age (β-ESR = 0.017, p < 0.001 and β-CRP = 0.009, p = 0.006), independent of the number of tender and swollen joints, general health, and sex. For each decade of aging, ESR and CRP levels became 1.19 and 1.09 times higher, respectively. Furthermore, women demonstrated average ESR levels that were 1.22 times higher than that of men (β = 0.198, p = 0.007), whereas men had 1.20 times higher CRP levels (β = -0.182, p = 0.048). Effects were strongest on the ESR. BMI became significantly associated with both inflammatory markers after 1 year, showing higher levels with increasing weight. Age continued to be significantly associated, whereas sex remained only associated with the ESR level. CONCLUSIONS: Age and sex are independently associated with the levels of both acute phase reactants in early RA, emphasizing the need to take these external factors into account when interpreting disease activity measures. BMI appears to become more relevant at later stages of the disease.
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spelling pubmed-42281882014-11-13 How age and sex affect the erythrocyte sedimentation rate and C-reactive protein in early rheumatoid arthritis Siemons, Liseth ten Klooster, Peter M Vonkeman, Harald E van Riel, Piet LCM Glas, Cees AW van de Laar, Mart AFJ BMC Musculoskelet Disord Research Article BACKGROUND: The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are two commonly used measures of inflammation in rheumatoid arthritis (RA). As current RA treatment guidelines strongly emphasize early and aggressive treatment aiming at fast remission, optimal measurement of inflammation becomes increasingly important. Dependencies with age, sex, and body mass index have been shown for both inflammatory markers, yet it remains unclear which inflammatory marker is affected least by these effects in patients with early RA. METHODS: Baseline data from 589 patients from the DREAM registry were used for analyses. Associations between the inflammatory markers and age, sex, and BMI were evaluated first using univariate linear regression analyses. Next, it was tested whether these associations were independent of a patient’s current disease activity as well as of each other using multiple linear regression analyses with backward elimination. The strengths of the associations were compared using standardized beta (β) coefficients. The multivariate analyses were repeated after 1 year. RESULTS: At baseline, both the ESR and CRP were univariately associated with age, sex, and BMI, although the association with BMI disappeared in multivariate analyses. ESR and CRP levels significantly increased with age (β-ESR = 0.017, p < 0.001 and β-CRP = 0.009, p = 0.006), independent of the number of tender and swollen joints, general health, and sex. For each decade of aging, ESR and CRP levels became 1.19 and 1.09 times higher, respectively. Furthermore, women demonstrated average ESR levels that were 1.22 times higher than that of men (β = 0.198, p = 0.007), whereas men had 1.20 times higher CRP levels (β = -0.182, p = 0.048). Effects were strongest on the ESR. BMI became significantly associated with both inflammatory markers after 1 year, showing higher levels with increasing weight. Age continued to be significantly associated, whereas sex remained only associated with the ESR level. CONCLUSIONS: Age and sex are independently associated with the levels of both acute phase reactants in early RA, emphasizing the need to take these external factors into account when interpreting disease activity measures. BMI appears to become more relevant at later stages of the disease. BioMed Central 2014-11-06 /pmc/articles/PMC4228188/ /pubmed/25373740 http://dx.doi.org/10.1186/1471-2474-15-368 Text en © Siemons et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Siemons, Liseth
ten Klooster, Peter M
Vonkeman, Harald E
van Riel, Piet LCM
Glas, Cees AW
van de Laar, Mart AFJ
How age and sex affect the erythrocyte sedimentation rate and C-reactive protein in early rheumatoid arthritis
title How age and sex affect the erythrocyte sedimentation rate and C-reactive protein in early rheumatoid arthritis
title_full How age and sex affect the erythrocyte sedimentation rate and C-reactive protein in early rheumatoid arthritis
title_fullStr How age and sex affect the erythrocyte sedimentation rate and C-reactive protein in early rheumatoid arthritis
title_full_unstemmed How age and sex affect the erythrocyte sedimentation rate and C-reactive protein in early rheumatoid arthritis
title_short How age and sex affect the erythrocyte sedimentation rate and C-reactive protein in early rheumatoid arthritis
title_sort how age and sex affect the erythrocyte sedimentation rate and c-reactive protein in early rheumatoid arthritis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4228188/
https://www.ncbi.nlm.nih.gov/pubmed/25373740
http://dx.doi.org/10.1186/1471-2474-15-368
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