Summary
A number of laboratory variables, including Hb., ESR and several phase proteins, fluctuated in concord with the clinical signs of synovitis activity in patients with rheumatoid arthritis during a controlled study of 3 disease-modifying anti-rheumatic drugs (DMARD). The correlation between laboratory variables and clinical synovitis was significant in a large patient population but the correlation coefficients were not of such magnitude that any of the laboratory variables reflected clinical synovitis activity in a reliable manner in the individual patients. In patients treated with azathioprine, the response of the Hb, (and consequently of the ESR), was reduced compared to patients given other DMARD. This phenomenon was caused by the bone marrow suppressing effect of azathioprine. However, the effect of azathioprine on the clinical synovitis activity did not differ from that of the 2 other drugs. Similar results were found by reviewing the literature about controlled trials of DMARD. In the present trial the clinical evaluation was performed under optimal conditions. In daily clinical practice the evaluations of the joints may be less than optimal since they may be performed by different rheumatologists with varying experience. Consequently, it may be difficult to do without the unreliable laboratory variables mentioned in the routine assessments of disease activity, unless the quality of routine evaluations of synovitis activity is improved considerably.
Similar content being viewed by others
References
Halberg, P., Bentzon, M.W., Crohn, O., Gad, I., Halskov, O., Heyn, J., Ingeman, M., Junker, P., Lorenzen, I., Møller, I., Mørk Hansen, T., Olsen, N., Pedersen, G., Sørensen, S.F., Stage, P. Double-blind trial of levamisole, penicillamine and azathioprine in rheumatoid arthritis. Dan Med Bull 1984, 31, 403–9.
Bentzon, M.W., Gad, I., Halberg, P., Halskov, O., Jacobsen, B.K., Lorenzen, I., Morling, N., Svejgaard, A. Influence of previous gold treatment and other patient variables on treatment with disease modifying anti-rheumatic drugs. Clin Rheumatol 1986, 5, 59.
McCarty, D.J. Methods for Evaluating Rheumatoid Arthritis in Arthritis and Allied Conditions. Ed: Hollander, J.E., McCarty, D.J., Lea & Febriger, Philadelphia, 1972, pp. 419.
Grindulis, K.A., Calverley, M., Constable, T.J., Forster, P.J.G., Khalafalla Ahmed, M.E., McConkey, B. A comparison between clinical and laboratory tests in rheumatoid arthritis. Scand J Rheumatol 1983, 12, 285–288.
Dixon, J.S., Pickup, M.E., Lowe, J.R., Hallett, C., Lee, M.R., Wright, V. Discriminatory indices of response of patients with rheumatoid arthritis treated with D-penicillamine. Ann Rheum Dis 1980, 39, 301–311.
Ingeman-Nielsen, M., Halskov, O., Mørk Hansen, T., Halberg, P., Stage, P., Lorenzen, I. Clinical synovitis and radiological lesions in rheumatoid arthritis. Scand J Rheumatol 1983, 12, 237–240.
Halberg, P. Controlled, double-blind, comparative studies of disease modifying anti-rheumatic drugs in the treatment of patients with rheumatoid arthritis. Dan Med Bull 1984, 31, 391–402.
Paulus, H.E., Williams, H.J., Ward, J.R., Reading, J.C., Egger, M.I., Coleman, M.L., Samuelson, C.O., Willkens, R.F., Guttadauria, M., Alarcon, G.S., Kaplan, S.B., Maclaughin, E.J., Weinstein, A., Wilder, R.L., Solsky, M.A., Meenan, R.F. Azathioprine versus D-penicillamine in rheumatoid arthritis patients who have been treated unsuccessfully with gold. Arthritis Rheum 1984, 27, 721–727.
Holdstock, G., Mitchell, I.R.A. Erythrocyte sedimentation rate before and after in-vitro defibrination: A rapid and simple method for increasing its specificity. Lancet 1977, II, 1314–16.
Böttinger, L.E., Svedberg, C.A. Normal erythrocyte sedimentation rate and age. Br Med J 1967, 12, 85–87.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bentzon, M.W., Gad, I., Halberg, P. et al. Acute phase proteins and clinical synovitis activity in patients with rheumatoid arthritis. Clin Rheumatol 6, 226–232 (1987). https://doi.org/10.1007/BF02201028
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02201028