Alimentary TractCorrelation between levels of C-reactive protein and clinical activity in Crohn's disease
Introduction
Crohn's disease (CD) is characterized by flare-ups alternating with periods of remission. The assessment of CD activity is key when it comes to determining the therapeutic approach and to predicting the response to treatment [1]. This assessment can be carried out using clinical disease activity indices like the Crohn's disease activity index (CDAI), the most tested and proven clinical score in CD [2]. Other ways to measure CD activity are endoscopical and histological examination, accurate but invasive and expensive.
Biochemical markers are widely used in clinical practice in CD to measure inflammation and mirror disease activity. C-Reactive Protein (CRP), an acute phase reactant, is one of the most commonly used markers [3]. Its value is often elevated in patients with severe disease. Several studies found a positive correlation between CRP levels and CD activity based on endoscopical, histological and radiological findings or clinical scores, such as the Van Hees index [4], [5], [6]. However, although CDAI is the most used clinical score in CD, the correlation between CRP levels and CDAI has been poorly documented [3].
The aims of our study are to:
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Determine factors associated with an increased CRP level in CD patients.
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Examine the correlation between CRP levels and clinical activity, as measured by CDAI.
Section snippets
Patients
We prospectively studied 103 consecutive CD patients recruited in our department between January 2005 and June 2006. Exclusion criteria were current associated malignancy, previous intestinal resection and infection within the previous month.
Methods
The disease duration was specified for all patients. The disease site was determined either by endoscopical or radiological investigations carried out within a period of 6 months before the time of inclusion. The presence of anal fistula, and extra
Study population
Characteristics of included patients are represented in Table 1. At the time of inclusion, 78 patients (76%) had an active disease, 25 (24%) were in remission. The disease activity was found mild, moderate and severe in respectively 23, 35 and 20 patients. At the time of the blood tests, 14 patients were being treated with azathioprine and 7 with mesalazine. No one was undergoing steroid treatment at the moment of inclusion, although 23 patients had received prior corticosteroid treatment.
CRP values
The
Discussion
The prevalence of Crohn's disease varies geographically. Tunisia is considered as a zone of low incidence. In fact, in a study concerning east-central Tunisia, the incidence is about 1.24/10,000 inhabitants [7]. Our population differs from European and American patients by an absence of any significant association with NOD2/CARD15 gene polymorphism [8].
The CDAI is the most frequently used index in everyday practice as in clinical trials. However, the CDAI has some limitations: this score
Conflict of interest statement
None declared.
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