ARD Online First, published on January 7, 2013 as 10.1136/annrheumdis-2012-202504
Serum levels of hs-CRP in patients with normal CRP values (<5 mg/l)
ASAS, Assessment of SpondyloArthritis international Society; CRP, C-reactive protein.
The average delay in axial spondyloarthri-tis (axSpA) diagnosis after symptom onsetis one of the longest among inflammatory
patients without SpA had sacroiliitis, so
Bichat, Joëlle Benessiano) was in charge of
centralising and managing biological data
of the ASAS axSpA criteria. In the clinical
bidimetry (Roche Diagnostics, Switzerland).
national Society (ASAS) SpA criteria,3 and
positive hsCRP and CRP were ≥2 mg/l and
sensitive tests, so-called high-sensitivity
Sociodemographic—and IBP characteristics
and imaging—and lab results are displayed
in table 1. Serum levels of CRP were higher
rheumatic chronic inflammatory diseases,7
In the subgroup of patients with negative
and show a better correlation with disease
CRP, mean serum levels of hsCRP were also
patients. Future studies including patients
activity parameters compared with routine
Victoria Navarro-Compán,1 Désirée van der
aim of this study was to assess the contri-
Heijde,1 Bernard Combe,2 Claudine Cosson,3
bution of hsCRP versus CRP to classifica-
difference was not statistically significant
1Department of Rheumatology, Leiden University
(p=0.06) (table 2). Substituting the ASAS
classification criteria for the probability of
2Department of Rheumatology, Hôpital Lapeyronie,
inflammatory back pain (IBP) duration of
SpA according to the treating physician,9
3Department of Biochemistry, Hôpital Bicêtre,
more than 3 months, but less than 3 years,
also did not indicate increased levels of
Assistance Publique Hôpitaux de Paris, Paris, France
hsCRP in patients with a high probability of
Correspondence to Dr Victoria Navarro-Compán,
Indifferenciees Recentes cohort was used.
Department of Rheumatology, Leiden University
Medical Center, PO Box 9600, Leiden 2333 RC,
2011. Design, inclusion criteria, CRP mea-
surements using conventional methods, and
would be classified as axSpA substituting
Acknowledgements The DESIR cohort is conductedunder the control of Assistance Publique-Hopitaux deParis via the Clinical Research Unit Paris-Centre andunder the umbrella of the French Society ofRheumatology and INSERM (Institut National de la
Characteristics of patients with early inflammatory back pain from the DESIR cohort
Santé et de la Recherche Médicale). The databasemanagement is performed within the department of
epidemiology and biostatistics (Professor Jean-Pierre
Daurès, DIM, Nîmes, France). An unrestricted grantfrom Wyeth Pharmaceuticals was allocated for the first
5 years of the follow-up of the recruited patients. We
also wish to thank the different regional participatingcentres: Pr Maxime Dougados (Paris
Pr André Kahan (Paris—Cochin A), Pr Olivier Meyer
(Paris—Bichat), Pr Pierre Bourgeois (Paris—La
Pitié-Salpetrière), Pr Francis Berenbaum (Paris—Saint
Antoine), Pr Pascal Claudepierre (Créteil), Pr Maxime
Breban (Boulogne Billancourt), Dr BernadetteSaint-Marcoux (Aulnay-sous-Bois), Pr Philippe Goupille
(Tours), Pr Jean-Francis Maillefert (Dijon), Dr Xavier
ASAS, Assessment of SpondyloArthritis international Society; CRP, C-reactive protein; DESIR, Devenir des
Puéchal (Le Mans), Pr Daniel Wendling (Besançon),
Spondylarthopathies Indifferenciees Recentes.
Pr Bernard Combe (Montpellier), Pr Liana Euller-Ziegler
Copyright Article author (or their employer) 2013. Produced by BMJ Publishing Group Ltd (& EULAR) under licence.
(Nice), Dr Pascal Richette (Paris—Lariboisière), Pr Pierre
Hermann J, Giessauf H, Schaffler G, et al. Early
Lafforgue (Marseille), Dr Patrick Boumier (Amiens),
spondyloarthritis: usefulness of clinical screening.
Pr Jean-Michel Ristori (Clermont-Ferrand), Dr Nadia
Rheumatology (Oxford) 2009;48:812–6.
Mehsen (Bordeaux), Pr Damien Loeuille (Nancy),
Ridker PM, Danielson E, Fonseca FA, et al.
Pr René-Marc Flipo (Lille), Pr Alain Saraux (Brest),
Rosuvastatin to prevent vascular events in men and
Pr Corinne Miceli (Le Kremlin Bicêtre), Pr Alain
women with elevated C-reactive protein. N Engl J
Cantagrel (Toulouse), Pr Olivier Vittecoq (Rouen).
Nielen MM, van Schaardenburg D, Reesink HW,
Contributors VNC and FvG performed the statistical
Feldtkeller E, Khan MA, van der Heijde D, et al. Age
et al. Increased levels of C-reactive protein in serum
analysis. FvG and DvdH participated in the design of
at disease onset and diagnosis delay in HLA-B27
from blood donors before the onset of rheumatoid
the study and interpreted the results. VNC, DvdH, BC,
negative vs. positive patients with ankylosing
arthritis. Arthritis Rheum 2004;50:2423–7.
CC and FvG drafted the manuscript. All authors read
spondylitis. Rheumatol Int 2003;23:61–6.
Poddubnyy DA, Rudwaleit M, Listing J, et al.
Rudwaleit M, Landewé R, van der Heijde D, et al. The development of Assessment of SpondyloArthritis
Comparison of a high sensitivity and standard C reactive
Funding VNC was partially supported by a grant from
international Society classification criteria for axial
protein measurement in patients with ankylosing
the Fundación Andaluza de Reumatología.
spondyloarthritis ( part I): classification of paper
spondylitis and non-radiographic axial Spondyloarthritis.
patients by expert opinion including uncertainty
appraisal. Ann Rheum Dis 2009;68:770–6.
Dougados M, d’Agostino MA, Benessiano J, et al.
Ethics approval French Departmental Directorate of
Rudwaleit M, van der Heijde D, Landewé R, et al.
The DESIR cohort: a 10-year follow-up of early
The development of Assessment of SpondyloArthritis
inflammatory back pain in France: study design and
Provenance and peer review Not commissioned;
international Society classification criteria for axial
baseline characteristics of the 708 recruited patients.
The development of Assessment of SpondyloArthritis
international Society classification criteria for axial
Whicher JT. BCR/IFCC reference material for plasma
To cite Navarro-Compán V, van der Heijde D,
spondyloarthritis ( part II): validation and final
Combe B, et al. Ann Rheum Dis Published Online First:
selection. Ann Rheum Dis 2009;68:777–83.
Reference. International Federation of Clinical
[ please include Day Month year] doi:10.1136/
Rudwaleit M, van der Heijde D, Khan MA, et al.
Chemistry. Clin Biochem 1998;31:459–65.
How to diagnose axial spondyloarthritis early. Ann
Value of high-sensitivity C-reactive protein for classification of early axial spondyloarthritis: results from the DESIR cohort
Victoria Navarro-Compán, Désirée van der Heijde, Bernard Combe, etal. Ann Rheum Dis published online January 7, 2013doi: 10.1136/annrheumdis-2012-202504
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Clos tridi u m diffic ile Inf INDICATION: Acute onset diarrhea ( ≥ 3 unformed/watery stools in 24 hours) Do Not Use Abbreviations Positive stool C. difficile toxin test OR Pseudomembranous colitis on endoscopy OR high clinical suspicion pending toxin result -----------------------------------------------------------------------------------------