Does erythrocyte sedimentation rate reflect and discriminate flare from infection in systemic lupus erythematosus? Correlation with clinical and laboratory parameters of disease activity
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To examine disease activity parameters in patients with systemic lupus erythematosus (SLE) experiencing flare, infection, both, or neither condition, focusing on erythrocyte sedimentation rate (ESR). This study is a retrospective analysis of 371 consecutive inpatient SLE cases from 2006 to 2015. Cases were classified as flare (n = 147), infection (n = 48), both (n = 23), or neither (n = 135). ESR levels were correlated to C-reactive protein (CRP), ferritin, anti-dsDNA antibodies, complement C3 reduction, serositis, and erythrocyturia with proteinuria (Pearson’s correlation). ESR levels were related to an age- and gender-adapted cut-off value (ESRp). We analyzed mean values of age, ESR, ESRp, CRP, ferritin and distribution of anti-dsDNA antibodies, C3 reduction, serositis, and erythrocyturia with proteinuria. Sensitivity and specificity were calculated via receiver operating characteristic or two-by-two table. Association of parameters with disease activity and infection was tested via two-sided chi square test. ESR correlated moderately with CRP in cases with flare and/or infection (r = 0.505–0.586). While ESR and CRP were normal in remission, mean values overlapped in cases with flare, infection, or both. ESRp was higher in flare than in infection (p = 0.048). ESR lost association to activity in infected cases, CRP to infection in flaring cases. ESRp, serositis, and anti-dsDNA antibodies were related to disease activity regardless of infections. Anti-dsDNA antibodies were most sensitive for detecting flares (74%), while serositis, proteinuria with erythrocyturia, anti-dsDNA antibodies, C3 reduction, and ESRp values ≥ 2 were most specific. ESR levels were raised by flares, infections, and age; adapting them to age and gender increased their diagnostic value. Obtaining several parameters remains necessary to differentiate flare from infection.
KeywordsDisease activity Erythrocyte sedimentation rate Infection Inflammation Systemic lupus erythematosus
We thank Bernd Schicke from the department of statistics of the Tumorzentrum Berlin for assisting with statistical analysis.
Compliance with ethical standards
This work was carried out in accordance with the Declaration of Helsinki. The ethics committee of the Berlin board of physicians (Berliner Ärztekammer) approved the study protocol (Eth-23-16).
- 2.Paulus HE, Ramos B, Wong WK, Ahmed A, Bulpitt K, Park G, Sterz M, Clements P (1999) Equivalence of the acute phase reactants C-reactive protein, plasma viscosity, and Westergren erythrocyte sedimentation rate when used to calculate American College of Rheumatology 20% improvement criteria or the Disease Activity Score in patients with ea. J Rheumatol 26:2324–2331PubMedGoogle Scholar
- 4.Cantini F, Salvarani C, Olivieri I, Macchioni L, Ranzi A, Niccoli L, Padula A, Boiardi L (2000) Erythrocyte sedimentation rate and C-reactive protein in the evaluation of disease activity and severity in polymyalgia rheumatica: a prospective follow-up study. Semin Arthritis Rheum 30:17–24. https://doi.org/10.1053/sarh.2000.8366 CrossRefPubMedGoogle Scholar
- 10.Yee CS, Farewell V, Isenberg DA, Rahman A, Teh LS, Griffiths B, Bruce IN, Ahmad Y, Prabu A, Akil M, McHugh N, D’Cruz D, Khamashta MA, Maddison P, Gordon C (2007) British Isles Lupus Assessment Group 2004 index is valid for assessment of disease activity in systemic lupus erythematosus. Arthritis Rheum 56:4113–4119. https://doi.org/10.1002/art.23130 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Moustopoulos HM, Mavridis AK, Acritidis NC, Avgerinos PC (1983) High C-reactive protein response in lupus polyarthritis. Clin Exp Rheumatol 1:53–55Google Scholar
- 21.Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725. https://doi.org/10.1002/1529-0131(199709)40:9<1725::AID-ART29>3.0.CO;2-Y CrossRefPubMedGoogle Scholar
- 23.Schäfer VS, Weiß K, Krause A, Schmidt WA (2017) Does erythrocyte sedimentation rate reflect disease activity in patients with systemic lupus erythematodes? Correlation with acute phase reactants, immunological parameters and proteinuria [abstract]. Ann Rheum Dis 76:1239-1240Google Scholar
- 27.Bertsias G, Ioannidis JPA, Boletis J, Bombardieri S, Cervera R, Dostal C, Font J, Gilboe IM, Houssiau F, Huizinga T, Isenberg D, Kallenberg CG, Khamashta M, Piette JC, Schneider M, Smolen J, Sturfelt G, Tincani A, van Vollenhoven R, Gordon C, Boumpas DT, Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (2008) EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis 67:195–205. https://doi.org/10.1136/ard.2007.070367 CrossRefPubMedGoogle Scholar
- 28.Mosca M, Tani C, Aringer M, Bombardieri S, Boumpas D, Brey R, Cervera R, Doria A, Jayne D, Khamashta MA, Kuhn A, Gordon C, Petri M, Rekvig OP, Schneider M, Sherer Y, Shoenfeld Y, Smolen JS, Talarico R, Tincani A, van Vollenhoven RF, Ward MM, Werth VP, Carmona L (2010) European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies. Ann Rheum Dis 69:1269–1274. https://doi.org/10.1136/ard.2009.117200 CrossRefPubMedGoogle Scholar