Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Plasma Fibrinogen Better Reflects patients' Functional Ability in Polymyalgia Rheumatica Than Either ESR or CRP.

McCarthy,  EM, MacMullan,  Paul A., Al-Mudhaffer,  S., Madigan,  Anne M., Donnelly,  S., McCarthy,  C. J., McCarthy,  G M.

Background/Purpose:

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.Previously we have demonstrated the enhanced specificity of fibrinogen over the standard biomarkers ESR and CRP for the detection of treatment response in patients with active PMR. The usefulness of patient reported outcomes(PROs) is increasingly being recognised in rheumatic disease. PROs reflect the impact of disease and its trearment from the patients perspective.Any biomarker that accurately reflects PROs in PMR would be of benefit in the clinical setting.

Objectives:

To assess the correlation between patient reported outcomes(PROs) and the biomarkers fibrinogen, ESR and CRP in PMR.

Methods:

60 patients with PMR were divided into Active disease (group 1, n=25) or Inactive disease (group 2, n=35), based on symptoms, physician assessment and the standard biomarkers, ESR and CRP. Plasma fibrinogen was also measured. Groups underwent clinical and laboratory assessment at baseline and 6 weeks. PRO data collected included: Visual Analogue Scale(VAS) for patient assessment disease activity (VasDA), VAS for patient assessment of Quality of Life (VasQoL) and Health Assessment Questionnaire(HAQ). Demographic data were assessed using Fischers Exact Test and between group disease activity by Wilcoxon Signed Rank Test. Spearman's rank correlation coefficient was used to compare all biomarkers with the PROs. Standardised response means, a measure of a tests responsiveness to change, with a higher score indicating greater responsiveness were calculated for all 3 biomarkers.

Results:

Demographic data was similar in all groups.There were significant differences in steroid dose between groups (15mg v 5mg) reflecting the institution of steroid therapy in the active group (p<.001). Mean scores for all PROs and biomarkers improved significantly in the Active group between week 1 and week 6(p<0.001).There was no significant difference between week 1 and 6 scores in the Inactive group (Table 1).

Table 1. Mean Scores for Patient Reported Outcomes and Biomarkers

 Active PMR-Week 1Active PMR-Week 6Wilcoxon p valueInactive PMR – Week 1Inactice PMR – Week 6Wilcoxon p value
HAQ1.51.51<.001.53.49n/s
VASDA7.382.78<.0012.192.14n/s
VASQoL7.583.13<.0012.082.19n/s
Fibrinogen(g/L)5.23.49<.0013.233.24n/s
ESR(mm/hr)59.624.3<.00117.618.3n/s
CRP (mg/L)45.912.6<.0015.25.3n/s

All biomarkers showed significant correlation with the PROs (p<.005). Overall Fibrinogen showed superior correlation coefficients with the various PROs than either of the standard biomarkers ESR or CRP.

Table 2. Correlation coefficients of Patient Reported Outcomes and Biomarkers

 HAQVASDAVASQoL
Fibrinogen.51.64.61
ESR.45.57.57
CRP.39.62.64

Standardised Response Means for Fibrinogen, ESR and CRP were 1.63,1.2 and 1.05 respectively, indicating that plasma fibrinogen is the most responsive biomarker for assessment of change in disease activity.

Conclusion:

Plasma fibrinogen better reflects PROs in PMR than the standard biomarkers ESR or CRP. It is also more responsive to changes in disease activity than either ESR or CRP. None.

To cite this abstract, please use the following information:
McCarthy, EM, MacMullan, Paul A., Al-Mudhaffer, S., Madigan, Anne M., Donnelly, S., McCarthy, C. J., et al; Plasma Fibrinogen Better Reflects patients' Functional Ability in Polymyalgia Rheumatica Than Either ESR or CRP. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1515
DOI:

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