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Acute phase reactants in the initial phase of giant cell arteritis
Insights
For giant cell arteritis (GCA) treatment, C-reactive protein (CRP) and fibrinogen normalized quickly. Erythrocyte sedimentation rate (ESR) also decreased, making it sufficient for monitoring initial corticosteroid therapy.
Area of Science:
- Rheumatology
- Internal Medicine
- Clinical Immunology
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis requiring prompt immunosuppression.
- Monitoring treatment response is crucial for managing GCA and preventing complications.
Purpose of the Study:
- To evaluate the kinetics of inflammatory markers during initial corticosteroid treatment for GCA.
- To determine the most reliable marker for monitoring early treatment response in GCA patients.
Main Methods:
- Prospective weekly monitoring of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fibrinogen, and haptoglobin.
- 18 patients with 19 episodes of GCA receiving initial corticosteroid therapy were included.
Main Results:
- Fibrinogen and CRP showed the most rapid decrease, with 67% of patients achieving normal levels within two weeks.
- Erythrocyte sedimentation rate (ESR) normalized in 56% after two weeks and 76% after five weeks.
- Haptoglobin normalized slowest, with only 29% of patients having normal levels after two weeks and 75% after six weeks.
Conclusions:
- While CRP and fibrinogen decrease rapidly, ESR is a sufficient and reliable marker for monitoring initial corticosteroid treatment in GCA.
- Haptoglobin is the slowest normalizing marker and may be less useful for early treatment assessment.
Abstract:
The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fibrinogen and haptoglobin were followed weekly during the initial phase of corticosteroid treatment in 18 patients with 19 episodes of giant cell arteritis (GCA). Fibrinogen and CRP decreased most rapidly, with normal values in 67% of the patients after two weeks of treatment. After two weeks 56% of the patients had normal ESR values and 76% after five weeks. Haptoglobin normalised most slowly, no patient having a normal value after one week, 29% after two weeks and 75% after six weeks. For routine clinical use, we found the ESR alone sufficient for monitoring the initial steroid treatment.