Original ArticlePrevalence of a Normal C-Reactive Protein with an Elevated Erythrocyte Sedimentation Rate in Biopsy-Proven Giant Cell Arteritis
Section snippets
Materials and Methods
A retrospective, longitudinal, comparative study was performed. Chart review and data collection were conducted in the ophthalmology departments of 6 major tertiary-care university-affiliated medical centers from August 2004 through June 2005. Deidentified data were then sent to the coordinating center at The Johns Hopkins Hospital for final analysis. The study sample consisted of 119 patients with biopsy-proven GCA who had pretreatment ESR and CRP assays drawn between 1994 and 2005, a time
Demographic Characteristics
Of the 119 patients in this study, 87 (73.1%) were female. The mean age at presentation was 75.8, with a range of 52 to 97 years.
Erythrocyte Sedimentation Rate and C-Reactive Protein Levels
In this study, 99 of the 119 patients (83.2%) presented with both an elevated pretreatment ESR and CRP. As shown in Table 1, the ESR was elevated in 88 of these patients using both formulas. The other 11 patients had an elevated ESR by the Hayreh et al formula but not the Miller et al formula. Seventeen patients (14.3% of the original 119 patients) had a normal
Discussion
Visual loss is the most common devastating and irreversible complication of GCA and can be prevented with treatment. The first step in management, therefore, is early and accurate diagnosis. It is clear from previous studies that both the ESR and the CRP are highly sensitive tests for the diagnosis of GCA and that their combination increases the sensitivity further.5, 9, 11, 12, 13 Because the CRP is an acute-phase plasma protein that rises before ESR in most disease states, we hypothesized
Acknowledgments
The authors are indebted to Dr Susan Vitale, Johns Hopkins Hospital, for her assistance with the statistical analysis for the manuscript.
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Manuscript no. 2005-1178.
The authors have no commercial or proprietary interest in the products or companies mentioned in the article.