Lack of CRP response in patients with active RA - follow-up study
Research type
Research Study
Full title
Lack of CRP response in patients with active Rheumatoid Arthritis, as defined by ultrasound evidence of synovitis - What are the clinical implications and immunological causes? Follow-up study
IRAS ID
279352
Contact name
Jessica Manson
Contact email
Sponsor organisation
University College London
Clinicaltrials.gov Identifier
Z6364106/2020/02/109 , UCL Data Protection Registration, reference No
Duration of Study in the UK
0 years, 11 months, 30 days
Research summary
Rheumatologist-led musculoskeletal ultrasound clinics are used increasingly to assess for joint erosions and disease activity in patients with rheumatoid arthritis (RA). Using this technique we identified an atypical subgroup of RA patients who have active disease demonstrated on the scan, but do not have elevated inflammation levels in the blood (C-reactive protein (CRP) levels). In a previous study we investigated whether this unusual presentation was associated with either a delay in diagnosis or in relative under treatment, risking worse disease outcome and disability. In this study at the time of recruitment, all patients (~50) had active RA as defined by the presence of positive Power Doppler signal. The patients were split on the basis of the whether they did (hCRP), or did not (nCRP), mount CRP response. The data has recently been published and revealed that RA patients who do not mount an appropriate CRP response:
1. Experienced significantly worse care: Time to diagnosis and time to first disease modifying anti-rheumatic drug (DMARD) initiation were both significantly longer, despite all other patient/disease parameters being comparable between the 2 patient groups
2. Had disease that was difficult to control: despite persistently normal CRP levels, 30% of patients in the nCRP cohort still had a disease activity score consistent with very active disease.
3. Responded less well to conventional DMARDs:
4. Were immunologically distinct: nCRP patients had significant immunological differences compared to hCRP patients including significantly increased regulatory T-cell (Treg) frequencies that correlated positively with predictors of poor disease outcome and altered activation of complement.
We now want to confirm these findings in a larger cohort of patients and generate data to support a clinical study to improve treatment algorithms for this atypical RA patient subset.
Blood samples (on a maximum of 3 occasions, with 2 of these optional) & data only from routine clinal Ultrasound scans will be collected.REC name
London - Hampstead Research Ethics Committee
REC reference
20/PR/0441
Date of REC Opinion
5 Nov 2020
REC opinion
Favourable Opinion