Journal List > J Rheum Dis > v.21(1) > 1064121

Koo, Hong, Kim, Kim, Lee, and Yoo: Clinical Characteristics of Patients with Rheumatoid Arthritis Who have Sustained High Erythrocyte Sedimentation Rates after Clinical Remission

Abstract

Objective

The aim of this study is to determine the clinical characteristics of patients with rheumatoid arthritis (RA) sustaining high erythrocyte sedimentation rate (ESR) despite clinical remission.

Methods

This cross-sectional study involved 91 patients, who visited a tertiary medical center. Patients underwent laboratory tests and a physical examination by a rheumatologist. The disease activity score (DAS) was calculated and patients who were in remission (defined as DAS28-CRP <2.6) were selected. Patients were divided into two groups: those with high and low ESRs (≥40 and <40 mm/hr, respectively).

Results

DAS 28-CRP scores revealed that 61 of the 91 patients were in remission. Of these 61 patients, 15 and 46 were allocated to the high and low ESR groups, respectively. Compared to the low ESR group, the high ESR group had a longer disease duration (99.2±60.2 vs. 59.1±48.9 months), significantly higher white blood cell counts, and CRP levels, total modified Sharp radiographic joint scores, and erosion scores, as well as significantly lower hemoglobin, albumin and alanine aminotransferase levels.

Conclusion

Patients who have high ESRs despite their remission status may show progressive radiographic change. In such patients, additional treatments that decreases the inflammation and prevents radiological progression should be considered.

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Table 1.
Baseline characteristics, disease activity index, and radiological findings of patients in remission who were divided into high and low erythrocyte sedimentation rate groups
  Low ESR (N=46) High ESR (N=15) p-value
Age (years) 60.1±10.8 62.7±9.2 NS
M:F ratio 12:34 4:11 NS
BMI (kg/m2) 23.5±3.4 23.30±3.02 NS
Disease duration (months) 59.1±49 99.2±60.2 0.023
Seropositive RA 87% 100% NS
Swelling joint count 0.2±0.6 0.4±0.8 NS
Tenderness joint count 0.3±0.6 0.4±0.6 NS
DAS28-ESR 2.3±0.6 3.4±0.4 0.000
DAS28-CRP 1.7±0.4 2.0±0.5 0.023
SDAI 2.7±2.6 3.4±2.6 NS
CDAI 2.4±2.6 2.6±2.3 NS
HAQ 0.3±0.4 0.3±0.4 NS
Erosion score, 0∼160 scale 4.2±7.5 12.2±11.0 0.005
Joint space narrowing score, 0∼120 scale 5.0±8.6 8.6±10.1 NS
Total modified Sharp score, 0∼280 scale 9.3±15.1 20.7±19.0 0.012

BMI: body mass index, CDAI: Clinical Disease Activity Index, CRP: C-reactive protein, DAS28: 28-joint Disease Activity Index, ESR: erythrocyte sedimentation rate, HAQ: Health Assessment Questionnaire, NS: not significant, RA: rheumatoid arthritis, SDAI: Simplified Disease Activity Index.

The data are shown as mean± SD or n.

The radiographic findings included the hands only.

Table 2.
Underlying diseases of patients in remission who were divided into high and low erythrocyte sedimentation rate groups
  Low ESR (N=46) High ESR (N=15) p-value
Osteoarthritis of knee 3 1 NS
Osteoporosis 10 2 NS
Compression fracture 2 0 NS
Hypertension 7 4 NS
Dyslipidemia 3 3 NS
Hepatitis B or C 1 1 NS
Asthma 2 0 NS
Chronic obstructive pulmonary disease 1 1 NS
Interstitial lung disease 3 1 NS
Heart failure 0 1 NS
History of tuberculosis 3 0 NS
History of malignancy 3 0 NS

CRP: C-reactive protein, ESR: erythrocyte sedimentation rate, NS: not significant.

Table 3.
Laboratory findings of patients in remission who were divided into high and low erythrocyte sedimentation rate groups
  Low ESR (N=46) High ESR (N=15) p-value
White blood cell count (×103/μ L) 6.6±2.2 8.4±3.2 0.036
Hemoglobin (g/dL) 12.9±1.3 12.1±1.3 0.046
Platelet count (×103/μ L) 231.9±57.7 267.7±65.7 NS
ESR (mm/hr) 20.6±12.7 71.1±18.4 0.000
CRP (mg/dL) 0.3±0.3 0.7±0.8 0.001
Aspartate aminotransferase (IU/L) 26.5±7.4 22.6±4.8 NS
Alanine aminotransferase (IU/L) 21.0±8.6 15.4±3.7 0.004
Alkaline aminotransferase (IU/L) 68.8±19.9 78.8±22.7 NS
Bilirubin (mg/dL) 0.8±0.2 0.7±0.2 NS
Creatinine (mg/dL) 0.8±0.2 0.8±0.2 NS
Uric acid (mg/dL) 4.3±1.2 4.3±1.4 NS
Glucose (mg/dL) 98.2±16.1 101.4±29.2 NS
Cholesterol (mg/dL) 176.9±31.0 186.6±35.2 NS
Albumin (g/dL) 4.1±.03 3.9±0.2 0.023
Protein (g/dL) 7.0±0.7 7.3±0.5 0.035

CRP: C-reactive protein, ESR: erythrocyte sedimentation rate, NS: not significant.

The data are shown as mean± SD.

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