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Serum amyloid A as a potent therapeutic marker in a refractory patient with polymyalgia rheumatica

Yasuhiro Shimojima1, Masayuki Matsuda, Takahisa Gono

  • 1Third Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan.

Internal Medicine (Tokyo, Japan)
|November 1, 2005
PubMed

Insights

Polymyalgia rheumatica (PMR) patients may relapse after tapering prednisolone. Serum amyloid A (SAA) may be a better marker of disease activity than CRP and ESR when symptoms persist despite normal inflammatory markers.

Area of Science:

  • Rheumatology
  • Immunology
  • Clinical Medicine

Background:

  • Polymyalgia rheumatica (PMR) is an inflammatory condition characterized by muscle pain and stiffness.
  • Standard inflammatory markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are used to monitor PMR activity.
  • Relapse can occur in PMR patients, particularly after reducing corticosteroid treatment.

Observation:

  • A patient with PMR experienced a relapse upon reducing oral prednisolone dosage.
  • Standard inflammatory markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) normalized with increased prednisolone, but symptoms persisted.
  • Serum amyloid A (SAA) levels decreased in parallel with symptom improvement.

Findings:

  • Flow cytometry revealed dynamic changes in immune cell populations, including an increase in CD8+CD25+ cells and decreases in CD4+CD25+ and CD4+CD45RA+ cells.
  • SAA levels correlated with clinical improvement, suggesting its utility as a marker for PMR activity.

Implications:

  • SAA may serve as a valuable therapeutic marker for monitoring PMR disease activity, especially when CRP and ESR are uninformative.
  • This finding could lead to more precise management strategies for PMR patients experiencing treatment challenges.

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