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Erythrocyte sedimentation rate, CRP level, and serum amyloid a protein for patient selection and monitoring of anti-tumor necrosis factor treatment in ankylosing spondylitis
Arthritis Care and Research , 11/02/09

de Vries MK et al. – The goal of this study was to study the usefulness of ESR, CRP, and serum amyloid A (SAA) for response prediction and monitoring of anti-tumor necrosis factor (anti-TNF) treatment in ankylosing spondylitis (AS) patients. ESR, CRP, and SAA were significantly associated with the BASDAI over 3 months, and the association with ESR was the strongest. Elevated baseline CRP and SAA levels revealed the highest predictive value for response. Together, this study demonstrates that inflammatory markers, and notably CRP and SAA, may facilitate patient selection and monitoring of efficacy of anti-TNF treatment in AS, and could be added to response criteria.

• Patients included consecutively before starting etanercept or infliximab treatment. ASsessment in Ankylosing Spondylitis (ASAS) response, defined as 50% improvement or absolute improvement of 2 points of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI; 0-10 scale), assessed at 3 months
• Inflammatory markers and BASDAI collected at baseline and 1 and 3 months
• Longitudinal data analysis performed to compare associations between inflammatory markers and BASDAI over time by calculating standardized betas
• Predictive values of baseline levels of inflammatory markers for ASAS response calculated

• 155 patients included
• After 3 months of treatment, 70% in etanercept cohort and 71% in the infliximab cohort responded
• All markers, notably SAA, decreased significantly
• Standardized betas 0.49 for ESR, 0.43 for CRP, and 0.39 for SAA
• Normal baseline levels of CRP and SAA significantly associated with nonresponse
• Combination of elevated CRP and SAA levels at baseline revealed highest predictive value (81%) for ASAS response

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