Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Plasma Fibrinogen Is More Specific Than Either ESR or CRP for Confirmation of Response to Treatment in Patients with Active Polymyalgia Rheumatica.

McCarthy2,  Eoghan M., MacMullan4,  Paul A., Al-Mudhaffer4,  Shibeb, Madigan4,  Anne, Donnelly4,  Suzanne, McCarthy3,  Conor J., Molloy5,  Eamonn S.

Mater Misericordiae Univ. Hosp, Dublin, Ireland
Mater Misericordiae University Hospital, Dublin, Ireland
Mater Misericordiae University Hospital, Dublin, Ireland
Mater Misericordiae University Hospital
St Vincent's University Hospital, Dublin, Ireland

Purpose:

To evaluate fibrinogen as a marker of disease activity in polymyalgia rheumatica (PMR).

Background:

Measurement of disease activity in PMR is challenging due to the subjective nature of symptoms and absence of consistent physical signs in an elderly population. ESR and CRP are used in clinical practice to guide therapeutic decisions. Both are non specific markers of inflammation. Disease activity in PMR has been shown to correlate with interleukin 6(IL6) levels. IL6 also regulates fibrinogen production. We sought to prospectively evaluate plasma fibrinogen as a biomarker of active inflammation in patients with PMR.

Methods:

60 patients with PMR (as per Jones Hazleman criteria) were divided into Active disease (group 1, n=25) or Inactive disease(group 2,n=35), based on symptoms, physician assessment and standard biomarkers ESR and CRP. Plasma fibrinogen was also assayed. Both groups underwent clinical and laboratory assessment at baseline and 6 weeks. The following disease activity data was collected: Duration of morning stiffness(mins), Visual Analogue Scale(VAS) for pain(Vaspain) and VAS for patient assessment of disease activity(VasDA). Demographic data and categorical variables were assessed using Fischers Exact Test. Between group disease activity data were assessed using Wilcoxon Signed Rank Test. Receiver operator curves (ROC), predictive values, and likelihood ratios were calculated for all biomarkers measured.

Results:

Demographic data was similar in all groups. Median steroid dose was 15mg (range 10 –60mg) in the active group and 5mg (range 0–15mg) in the inactive group. There were significant differences in steroid dose between the two groups(p<.001).Mean scores for Vas pain (7.44 versus 2.8), Vas disease activity (7.38 vs 2.77) and duration of morning stiffness(72mins vs 9mins) improved significantly in the Active group between week 1 and week 6 (p<0.001).Mean fibrinogen reduced from 5.2g/L to 3.5g/L (normal<4g/L) between weeks 1 and 6. ESR and CRP reduced from 59.6 mm/hr to 24.3 mm/hr (normal <20mm/hr) and 45.9mg/L to 12.66mg/L(normal<5mg/L). There was no significant difference between the mean disease scores at week 6 in the Active group and the Inactive group at either week 1 or 6

ROC curve analysis revealed fibrinogen to be more specific than either ESR or CRP for the detection of response to treatment in patients with active PMR (Fig 1).

Values above the upper limit of normal for fibrinogen, CRP and ESR were associated with likelihood ratios for active disease of 20.53, 2.9 and 2.8 respectively (p<0.001).

Conclusion:

Plasma fibrinogen was more specific for the confirmation of both active PMR and response to treatment than either ESR or CRP. While validation by other studies is required, this data suggests that measurement of fibrinogen as an adjunct to ESR and CRP in patients with suspected active PMR may enhance accuracy of diagnosis and guide therapeutic decisions.

To cite this abstract, please use the following information:
McCarthy, Eoghan M., MacMullan, Paul A., Al-Mudhaffer, Shibeb, Madigan, Anne, Donnelly, Suzanne, McCarthy, Conor J., et al; Plasma Fibrinogen Is More Specific Than Either ESR or CRP for Confirmation of Response to Treatment in Patients with Active Polymyalgia Rheumatica. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1306
DOI: 10.1002/art.29072

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