From the Guidelines
Elevated CRP levels should be addressed by identifying and treating the underlying cause, which may include infections, autoimmune disorders, or cardiovascular disease, and lifestyle modifications such as regular exercise, weight loss, and an anti-inflammatory diet. When CRP levels rise above the normal range (typically less than 10 mg/L), it suggests an inflammatory process is occurring. Common causes include infections (bacterial, viral, fungal), autoimmune disorders (rheumatoid arthritis, lupus), tissue injury, cardiovascular disease, and certain cancers. To address elevated CRP, the following steps can be taken:
- Identify and treat the underlying cause, such as prescribing antibiotics for infections or immunosuppressants for autoimmune conditions
- Recommend statins like atorvastatin (20-40mg daily) for cardiovascular risk
- Encourage lifestyle modifications, including:
- Regular exercise (30 minutes daily)
- Weight loss if overweight
- Smoking cessation
- An anti-inflammatory diet rich in fruits, vegetables, whole grains, and omega-3 fatty acids CRP is valuable as both a diagnostic marker and for monitoring treatment response, as levels typically decrease when inflammation resolves, as noted in studies such as 1. The degree of elevation often correlates with the severity of inflammation, with mild elevations (10-40 mg/L) suggesting chronic conditions and higher levels (>100 mg/L) typically indicating acute infections or severe inflammatory states, as discussed in 1. It is essential to consider the clinical context and potential causes of elevated CRP, as well as the patient's overall health and medical history, when interpreting CRP results and developing a treatment plan, as emphasized in 1 and 1.
From the Research
CRP Elevation and Disease Modifying Antirheumatic Drugs (DMARDs)
- CRP (C-reactive protein) elevation is a marker of inflammation, and DMARDs are used to reduce inflammation in various arthritic conditions 2.
- DMARDs can be classified into non-biological DMARDs (e.g., methotrexate, sulfasalazine, hydroxychloroquine) and biological DMARDs (e.g., tocilizumab, adalimumab, infliximab) 2.
- Biological DMARDs have shown more efficacy and lesser side effects compared to non-biological DMARDs, but their access is limited due to higher cost 2.
Mechanism of Action of DMARDs
- DMARDs act by different mechanisms against inflammation, including inhibition of tumor necrosis factor, suppression of IL-1 and TNF-α, induction of apoptosis of inflammatory cells, and inhibition of purine synthesis 2.
- The mechanism of action of DMARDs can affect CRP levels, as reduced inflammation can lead to decreased CRP elevation 2.
Biologic Agents and CRP Elevation
- Biologic agents, such as certolizumab, etanercept, and tocilizumab, have been shown to be effective in reducing inflammation and improving outcomes in patients with rheumatoid arthritis 3.
- The efficacy of biologic agents can be dependent on dose level, and higher doses may be associated with greater reductions in CRP elevation 3.
- Combination therapy with biologic agents and DMARDs may be more effective than monotherapy in reducing inflammation and improving outcomes 4.
Perioperative Management of Biologics and DMARDs
- The perioperative management of biologics and DMARDs is crucial in patients with rheumatoid arthritis undergoing arthroplasty, as continuing or withholding these medications can affect infection risk and disease flares 5.
- Some DMARDs, such as methotrexate and hydroxychloroquine, may be safe to continue in the perioperative period, while biologics may need to be withheld due to increased infection risk 5.
Safety of DMARDs and Biologic Agents
- The safety of DMARDs and biologic agents in real-life conditions has been evaluated, and factors such as age, disease duration, and combined therapy can affect the risk of adverse drug reactions 6.
- Combination therapy with methotrexate and biologic agents may be associated with a lower risk of discontinuation due to adverse drug reactions compared to other combinations 6.