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Association of Elevated Platelets and C-Reactive Protein With Severe Disease and Poor Survival in Systemic Sclerosis

Brian S Lee1, Shufeng Li1, Srijana Davuluri1

  • 1Stanford University, Stanford, California.

Arthritis Care & Research
|July 22, 2026
PubMed

Insights

Elevated platelets and C-reactive protein (CRP) together indicate severe systemic sclerosis (SSc) with poor survival. This dual elevation signals a need for proactive management of SSc complications.

Area of Science:

  • Rheumatology
  • Immunology
  • Clinical Medicine

Background:

  • Elevated C-reactive protein (CRP) is linked to severe systemic sclerosis (SSc) and reduced survival.
  • The prognostic significance of platelet levels in SSc remains less understood.
  • This study investigates the combined impact of elevated platelets and CRP on SSc outcomes.

Purpose of the Study:

  • To determine the association between elevated platelet levels, CRP levels, or both, and SSc disease severity.
  • To evaluate the relationship between these biomarkers and SSc progression.
  • To assess the impact of combined elevated platelets and CRP on SSc patient survival.

Main Methods:

  • Retrospective analysis of 139 adult SSc patients from 1996-2022.
  • Patients categorized into four groups based on first blood draw: normal/normal, normal platelet/elevated CRP, elevated platelet/normal CRP, and elevated platelet/elevated CRP.
  • Cutoffs used: platelets ≥330,000/μL and CRP ≥6.0 mg/L.

Main Results:

  • The elevated platelet/elevated CRP (EP/EC) group showed higher rates of Scl-70 antibodies, diffuse skin involvement, myocarditis, dysphagia, GAVE, joint contractures, and digital ulcers.
  • EP/EC patients had the highest modified Rodnan skin scores.
  • Median survival was significantly lower in the EP/EC group (9.6 years) compared to normal/normal (21.3 years), with a hazard ratio of 7.34.

Conclusions:

  • Combined elevated platelet and CRP levels identify SSc patients with severe disease and poor prognosis.
  • Patients with dual biomarker elevation may require intensified screening and treatment for complications.
  • Isolated elevation of either platelets or CRP was associated with intermediate disease severity.
Abstract

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