title: Elevated C-Reactive Protein Level Predicts Earlier Treatment with Tumor Necrosis Factor-Alpha Inhibitors in Psoriatic Arthritis.
abstract: BACKGROUND
  Tumor necrosis factor-alpha (TNFα) inhibitors are indicated for patients with psoriatic arthritis (PsA) in whom conventional disease-modifying anti-rheumatic drugs (DMARDs) are insufficient to achieve disease remission.
  
  
  OBJECTIVE
  To determine the value of acute-phase reactant levels at diagnosis of psoriatic arthritis in predicting the need for biologic treatment with TNFα inhibitors.
  
  
  METHODS
  We conducted a longitudinal observational study of an inception cohort of 71 consecutive patients diagnosed with psoriatic arthritis. C-reactive protein (CRP) was assayed for all patients at their first visit.
  
  
  RESULTS
  All patients were treated with one or more DMARDs, mainly methotrexate (81.6%). Thirty-seven patients (52.11%) had an inadequate response and received at least one TNF inhibitor. CRP level at diagnosis was positively correlated with need for a TNF inhibitor (P = 0.009, HR 1.8, 95% CI 1.27-1.85). Patients with CRP > 0.9 mg/dl at diagnosis started biologic treatment significantly earlier than patients with a lower level (P = 0.003, HR 2.62, 95% CI 0.393-2.5).
  
  
  CONCLUSIONS
  In patients with psoriatic arthritis, CRP ≥ 0.9 mg/dl at diagnosis significantly predicts an earlier need for a TNF inhibitor to achieve disease control.
authors.forename: Shachaf
authors.initials: S
authors.lastname: Ofer-Shiber
authors.forename: Yair
authors.initials: Y
authors.lastname: Molad
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects; D015535:Arthritis, Psoriatic / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D002097:C-Reactive Protein / Q000032:analysis*; D000068800:Etanercept / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage / Q000009:adverse effects; D007557:Israel / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D000069285:Infliximab; D000068800:Etanercept; D008727:Methotrexate