High-Sensitivity C-Reactive Protein as an Associate of Clinical Subsets and Organ Damage in Systemic Lupus Erythematosus

Shin Seok Lee, Sukhminder Singh, Kimberly Link, Michelle Petri

Research output: Contribution to journalArticle

Abstract

Objective: C-reactive protein (CRP) may play an anti-inflammatory role during the acute phase of inflammation and is also used as a marker of inflammation associated with cardiovascular disease. In the present study, we investigated the association between high-sensitivity CRP (hsCRP) and systemic lupus erythematosus (SLE) manifestations, autoantibodies, and organ damage. Methods: In this cross-sectional study, 610 SLE patients from a prospective cohort had more than 1 hsCRP measurement. Organ damage was assessed using the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology Damage Index. Multiple linear regression models were used to adjust for age, gender, ethnicity, disease duration, body mass index, education, disease activity, current prednisone dose, statin use, and estrogen use. Results: After adjusting for confounders, hsCRP was associated with myocarditis, cardiac murmur, interstitial pulmonary fibrosis, pulmonary hypertension, gastrointestinal lupus manifestations, and anemia. Anti-dsDNA antibodies and lupus anticoagulant were associated with hsCRP in unadjusted models, and these associations remained significant after adjustment for confounders. hsCRP levels were significantly higher in patients with pulmonary, musculoskeletal, and endocrine damage, and a total SLICC Damage Index score ≥1. After adjustment, hsCRP was associated with pulmonary, musculoskeletal, and total damage, but no longer with endocrine damage. Conclusions: hsCRP is associated with a broad range of clinical features and organ damage in SLE, particularly in the pulmonary and musculoskeletal systems. This association holds true independent of sociodemographic, disease activity, and treatment factors and may be useful to identify high-risk SLE patients who would benefit from additional screening and surveillance studies.

Original languageEnglish (US)
Pages (from-to)41-54
Number of pages14
JournalSeminars in Arthritis and Rheumatism
Volume38
Issue number1
DOIs
StatePublished - Aug 2008

Fingerprint

Systemic Lupus Erythematosus
C-Reactive Protein
Lung
Linear Models
Inflammation
Heart Murmurs
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Lupus Coagulation Inhibitor
Musculoskeletal System
Pulmonary Fibrosis
Myocarditis
Prednisone
Pulmonary Hypertension
Autoantibodies
Anemia
Anti-Idiotypic Antibodies
Estrogens
Body Mass Index
Anti-Inflammatory Agents
Cardiovascular Diseases

Keywords

  • C-reactive protein
  • cardiovascular risk factors
  • inflammation
  • systemic lupus erythematosus

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Orthopedics and Sports Medicine
  • Rheumatology

Cite this

High-Sensitivity C-Reactive Protein as an Associate of Clinical Subsets and Organ Damage in Systemic Lupus Erythematosus. / Lee, Shin Seok; Singh, Sukhminder; Link, Kimberly; Petri, Michelle.

In: Seminars in Arthritis and Rheumatism, Vol. 38, No. 1, 08.2008, p. 41-54.

Research output: Contribution to journalArticle

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AB - Objective: C-reactive protein (CRP) may play an anti-inflammatory role during the acute phase of inflammation and is also used as a marker of inflammation associated with cardiovascular disease. In the present study, we investigated the association between high-sensitivity CRP (hsCRP) and systemic lupus erythematosus (SLE) manifestations, autoantibodies, and organ damage. Methods: In this cross-sectional study, 610 SLE patients from a prospective cohort had more than 1 hsCRP measurement. Organ damage was assessed using the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology Damage Index. Multiple linear regression models were used to adjust for age, gender, ethnicity, disease duration, body mass index, education, disease activity, current prednisone dose, statin use, and estrogen use. Results: After adjusting for confounders, hsCRP was associated with myocarditis, cardiac murmur, interstitial pulmonary fibrosis, pulmonary hypertension, gastrointestinal lupus manifestations, and anemia. Anti-dsDNA antibodies and lupus anticoagulant were associated with hsCRP in unadjusted models, and these associations remained significant after adjustment for confounders. hsCRP levels were significantly higher in patients with pulmonary, musculoskeletal, and endocrine damage, and a total SLICC Damage Index score ≥1. After adjustment, hsCRP was associated with pulmonary, musculoskeletal, and total damage, but no longer with endocrine damage. Conclusions: hsCRP is associated with a broad range of clinical features and organ damage in SLE, particularly in the pulmonary and musculoskeletal systems. This association holds true independent of sociodemographic, disease activity, and treatment factors and may be useful to identify high-risk SLE patients who would benefit from additional screening and surveillance studies.

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