The correlations between C-reactive protein and MRI-detected inflammation in patients with axial spondyloarthritis: a systematic review and meta-analysis

Haoran Tian; Ting Li; Yuanqiong Wang; Hongjuan Lu; Li Lin; Xin Wu; Huji Xu

doi:10.1007/s10067-023-06658-w

The correlations between C-reactive protein and MRI-detected inflammation in patients with axial spondyloarthritis: a systematic review and meta-analysis

Clin Rheumatol. 2023 Sep;42(9):2397-2407. doi: 10.1007/s10067-023-06658-w. Epub 2023 Jun 19.

Authors

Haoran Tian^#¹, Ting Li^#¹, Yuanqiong Wang¹, Hongjuan Lu¹, Li Lin¹, Xin Wu¹, Huji Xu^{2

3

4}

Affiliations

¹ Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China.
² Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China. huji_xu@tsinghua.edu.cn.
³ Peking-Tsinghua Center for Life Sciences, Tsinghua University, Beijing, 100084, China. huji_xu@tsinghua.edu.cn.
⁴ School of Clinical Medicine, Tsinghua University, Beijing, 100084, China. huji_xu@tsinghua.edu.cn.

^# Contributed equally.

Abstract

Background: C-reactive protein (CRP) and magnetic resonance imaging (MRI) are widely used to monitor inflammation in patients with axial spondyloarthritis (axSpA), but the relationship between CRP and MRI-detected inflammation is incompletely understood. The present study was undertaken to assess correlations between CRP and MRI-detected inflammation in axSpA.

Materials and methods: A systematic literature search was performed (Medline, Embase, and Cochrane Library) to identify relevant studies concerning CRP and MRI-detected inflammation in axSpA patients. The MRI-detected inflammation was evaluated by MRI-based disease activity score (DAS). The correlation between CRP and MRI-based DAS was integrated by random-effect models.

Results: Eighteen studies reported a total of 1392 axSpA patients which were included in this meta-analysis. CRP was significantly associated with spinal MR DAS (r=0.226, 95%CI [0.149, 0.291], p<0.001, I²=23%). We also found a moderate correlation between CRP change and spinal MR DAS change (r[ASspiMRI-a]=0.354, 95%CI [0.282, 0.422], p<0.001, I²=48%; r[SPARCC]=0.544, 95%CI [0.345, 0.701], p<0.001, I²=19%). CRP at baseline was negatively associated with improvement in spinal MR DAS (r= - 0.327, 95%CI [-0.397, -0.264], p<0.001, I²=0%). However, no significant association was found between CRP and sacroiliac joint (SIJ) MR DAS.

Conclusions: In axSpA patients, CRP is associated with MRI-detected inflammation in the spine but not in SIJ. We speculate that CRP could be a reasonable index to reflect spinal inflammation. Therefore, we suggest it is not essential to repeat spinal MRI in a short term, while SIJ MRI may be necessary to provide additional information on inflammation. Key Points • CRP is associated with MRI-detected inflammation in the spine but not in sacroiliac joints. • CRP at baseline was negatively associated with improvement in spinal MR DAS. • It was not essential to repeat spinal MRI frequently, while SIJ MRI may be necessary to provide additional information on inflammation.

Keywords: Axial spondyloarthritis; C-reactive protein; Disease activity; Magnetic resonance imaging.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Axial Spondyloarthritis*
C-Reactive Protein / metabolism
Humans
Inflammation / pathology
Magnetic Resonance Imaging / methods
Sacroiliac Joint / diagnostic imaging
Sacroiliac Joint / pathology
Spondylarthritis* / diagnostic imaging
Spondylarthritis* / pathology

Substances

C-Reactive Protein