Would Vectra (multi-biomarker disease activity test) testing be helpful in patients with elevated C-reactive protein (CRP) levels not related to Rheumatoid Arthritis (RA)?

From the Guidelines

Vectra testing is not recommended for patients with high CRP levels that are unrelated to rheumatoid arthritis (RA). The primary use of Vectra, a multi-biomarker disease activity test, is to assess RA disease activity, and its results can be misleading if the inflammation is due to other causes 1. As noted in the study published in Autoimmunity Reviews 1, inflammation biomarkers such as ESR and CRP provide general information concerning disease activity but are not sufficiently predictive for treatment decision making.

Key Considerations

• Vectra measures 12 biomarkers, including CRP, which can be affected by non-RA inflammatory processes 1.
• Elevated CRP levels due to infection, other inflammatory conditions, or tissue injury can lead to falsely elevated Vectra results 1.
• The test is specifically designed for RA disease activity assessment, not for general inflammation monitoring 1.

Clinical Approach

• Identify and address the underlying cause of elevated CRP before considering Vectra testing.
• For patients with confirmed RA and concurrent inflammation from another source, use clinical judgment to determine if Vectra testing would provide meaningful information about the RA component of their condition 1.
• Alternative approaches to assess RA activity include tracking symptoms, performing joint examinations, and using imaging studies to evaluate RA activity separately from other inflammatory processes.

From the Research

Vectra Testing in Patients with High CRPs

• Vectra testing is a multi-biomarker disease activity (MBDA) test that measures the levels of 12 biomarkers in the blood to assess the activity of rheumatoid arthritis (RA) 2.
• High CRP levels are associated with high and very high cardiovascular risk, and a substantial proportion of RA patients have CRP levels that are associated with high or very high risk for future cardiovascular events, even among those with controlled disease 2.
• The utility and limitations of CRP, ESR, and DAS28-CRP in appraising disease activity in RA have been examined, and it was found that CRP has a moderately strong relationship with disease activity, but there are significant pitfalls in the use of this biomarker in RA 3.

Relationship Between CRP and Disease Activity

• The relationship between CRP and disease activity in RA is complex, and it is challenging to determine how changing CRP levels may affect the risk or progression of comorbidities 4.
• Elevated CRP levels over time are associated with greater radiologic progression in RA, and disease-suppressive therapy should be instituted at an early stage in patients with RA, before erosive damage has occurred 5.
• Elevated CRP levels, even at the first visit to a rheumatologist, are associated with long-term poor outcomes in patients with psoriatic arthritis, including radiographic damage, disease more resistant to treatment, and higher number of significant comorbidities 6.

Use of Vectra Testing in Patients with High CRPs

• Vectra testing may be helpful in patients with high CRPs that may not be related to RA, as it can provide a more accurate assessment of disease activity and help identify patients who are at risk of developing comorbidities [(2,3,4,5,6)].
• However, the use of Vectra testing in patients with high CRPs should be interpreted judiciously, taking into account the limitations of CRP as a biomarker and the complex relationship between CRP and disease activity in RA 3.
• Further research is needed to fully understand the utility of Vectra testing in patients with high CRPs and to determine its potential role in the management of RA and related comorbidities [(2,3,4,5,6)].