C‐Reactive Protein in Systemic Lupus Erythematosus

Abstract

The presence of C-reactive protein (CRP) was determined in the sera of 70 patients with systemic lupus erythematosus (SLE), 24 patients with rheumatoid arthritis (RA), and 17 patients hospitalized with acute infections. CRP (precipitin reaction > 3 mm) was present in only 2 of 50 patients with active, uncomplicated SLE (4%). However CRP was found in the sera of 11 patients with active SLE in the presence of superimposed infection. Treatment of the intercurrent infection resulted in the loss of CRP from the sera of these SLE patients. CRP was found in 85% of patients with active RA and in 100% of non-SLE infected patients. Appropriate treatment of the latter group resulted in loss of CRP from the convalescent sera. Corticosteroid therapy did not appear to influence the presence of CRP in the RA or SLE groups. Fourteen of 50 noninfected patients (28%) with active SLE were not receiving steroids at the time of CRP negativity. Appropriate experiments with mixed sera failed to demonstrate serum factors that could influence CRP precipitation in the CRP-negative SLE group. These studies suggest that patients with active SLE usually do not have CRP in their sera, and the results distinguish this group of patients from those with active RA, a disease generally marked by CRP positivity. Moreover, the finding of significant CRP precipitin in the sera of SLE patients may suggest the presence of superimposed infection.C-reactive protein (CRP) was first described by Tillet and Francis in 1930 in the sera of patients with pneumococcal pneumonia (1). Subsequently, its presence has been well documented in the sera of patients with rheumatic fever (2), rheumatoid arthritis (3-5), myocardial infarction, and other inflammatory states (3,6). The incidence of CRP in sera of patients with systemic lupus erythematosus is, however, not well established. To determine the incidence of CRP positivity in the sera of patients with SLE, 70 patients with SLE were studied. CRP positivity was then correlated with disease activity and superimposed infections. Seventeen non-SLE patients hospitalized with acute infections were studied to determine the duration of CRP positivity in various infectious states, and 24 patients with rheumatoid arthritis were also evaluated to assess the influence of corticosteroid therapy upon the presence of CRP in patients with a disease process known to be associated with CRP positivity (2).We utilized the semiquantitative, capillary precipitin reaction to determine the presence of CRP, rather than the more sensitive radioimmunoassay, which has demonstrated that minute amounts of CRP

Measurement of Complement Proteins C2 and B in Systemic Lupus erythematosus and Septic Shock

“…Our finding of normal CRP concentration in the majority of SLE pa tients, regardless of disease activity, is con sistent with the observations of Honig et al [1977], Pereira Da Silva et al [ ], Becker et al [1980 and Sitton et al [1987], In con trast, CRP concentration was observed to parallel disease activity in the SLE popula tions studied by Zein et al [1979] and Mor row et al [1981]. The variety of methods used, including semiquantitative capillary precipitation, radial immunodiffusion and radioimmunoassay have made interpreta tion and comparison somewhat difficult, es pecially in regard to the usefulness of ele vated CRP as indicative of infection in SLE patients.…”

High-Sensitivity C-Reactive Protein as an Associate of Clinical Subsets and Organ Damage in Systemic Lupus Erythematosus

“…Similarly, earlier investigators found no association between CRP levels and the patterns of organ involvement in SLE (4,7). However, investigators have recently described an association between CRP and musculoskeletal (8), pulmonary (9), and renal involvement in SLE (10).…”

“…Although earlier studies have suggested that active systemic lupus erythematosus (SLE) patients do not have elevated CRP levels (2)(3)(4), recent studies using a sensitive method have revealed that most SLE patients have elevated CRP levels during the evolution of the disease process, irrespective of concomitant active infection (5,6). Similarly, earlier investigators found no association between CRP levels and the patterns of organ involvement in SLE (4,7).…”

C‐Reactive protein: Current status and future perspectives

“…Other acute-phase proteins that generally have high initial normal 0 1987 Alan R. Liss, Inc. levels in serum include the following: a-acid glycoprotein, a -1 -antitrypsin, ceruloplasmin, fibrinogen, haptoglobin, and the protein closely related to CRP, serum amyloid P component (22,(24)(25)(26)(27). Elevation of CRP was generally minimal in the absences of tissue damages, as shown in one disease (28).…”