Peter C Grayson1, Paul A Monach2, Christian Pagnoux3, David Cuthbertson4, Simon Carette3, Gary S Hoffman5, Nader A Khalidi6, Curry L Koening7, Carol A Langford5, Kathleen Maksimowicz-McKinnon8, Philip Seo9, Ulrich Specks10, Steven R Ytterberg11, Peter A Merkel12. 1. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health, Bethesda, MD. 2. Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA. 3. Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada. 4. Department of Biostatistics, University of South Florida, Tampa, FL. 5. Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, OH, USA. 6. Division of Rheumatology, McMaster University, Hamilton, ON, Canada. 7. Division of Rheumatology, University of Utah, Salt Lake City, UT. 8. Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA. 9. Division of Rheumatology, Johns Hopkins University, Baltimore, MD. 10. Division of Pulmonary and Critical Care Medicine, Mayo Clinic of Medicine, Rochester. 11. Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN and. 12. Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA pmerkel@upenn.edu.
Abstract
OBJECTIVE: The aim of this study was to assess the clinical value of absolute eosinophil count, serum IgE, ESR and CRP as longitudinal biomarkers of disease activity and predictors of relapse in eosinophilic granulomatosis with polyangiitis (Churg-Strauss, EGPA). METHODS: Patients were selected from an observational EGPA cohort. Absolute eosinophil count, IgE, ESR and CRP were measured quarterly. Disease activity was defined by validated assessment tools. The association of tests with disease activity was assessed via regression models, adjusting for repeated measures and treatment status. Survival analysis was used to determine if laboratory tests were predictive of the 3 month future flare risk. RESULTS: Seventy-four per cent of 892 study visits in 141 patients occurred while patients were on treatment, mostly during remission or mild disease activity, defined as a BVAS for Wegener's granulomatosis (BVAS/WG) of 1 or 2. Correlations between absolute eosinophil count, IgE, ESR and CRP were mostly low or non-significant (r = -0.08 to 0.44). There were few weak associations with disease activity [absolute eosinophil count: OR) 1.01/100 U (95% CI 1.01, 1.02); ESR: OR 1.15/10 mg/l increase (95% CI 1.04, 1.27)]. When BVAS/WG ≥1 defined active disease, the absolute eosinophil count [hazard ratio (HR) 1.01/100 U (95% CI 1.01, 1.02)] was weakly predictive of flare. When BVAS/WG ≥3 defined active disease, ESR was weakly predictive of flare [HR 1.52/10 mm/h increase (95% CI 1.17, 1.67)]. CONCLUSION: The absolute eosinophil count, IgE, ESR and CRP have limitations as longitudinal biomarkers of disease activity or predictors of flare in EGPA. These findings suggest that novel biomarkers of disease activity for EGPA are needed.
OBJECTIVE: The aim of this study was to assess the clinical value of absolute eosinophil count, serum IgE, ESR and CRP as longitudinal biomarkers of disease activity and predictors of relapse in eosinophilic granulomatosis with polyangiitis (Churg-Strauss, EGPA). METHODS:Patients were selected from an observational EGPA cohort. Absolute eosinophil count, IgE, ESR and CRP were measured quarterly. Disease activity was defined by validated assessment tools. The association of tests with disease activity was assessed via regression models, adjusting for repeated measures and treatment status. Survival analysis was used to determine if laboratory tests were predictive of the 3 month future flare risk. RESULTS: Seventy-four per cent of 892 study visits in 141 patients occurred while patients were on treatment, mostly during remission or mild disease activity, defined as a BVAS for Wegener's granulomatosis (BVAS/WG) of 1 or 2. Correlations between absolute eosinophil count, IgE, ESR and CRP were mostly low or non-significant (r = -0.08 to 0.44). There were few weak associations with disease activity [absolute eosinophil count: OR) 1.01/100 U (95% CI 1.01, 1.02); ESR: OR 1.15/10 mg/l increase (95% CI 1.04, 1.27)]. When BVAS/WG ≥1 defined active disease, the absolute eosinophil count [hazard ratio (HR) 1.01/100 U (95% CI 1.01, 1.02)] was weakly predictive of flare. When BVAS/WG ≥3 defined active disease, ESR was weakly predictive of flare [HR 1.52/10 mm/h increase (95% CI 1.17, 1.67)]. CONCLUSION: The absolute eosinophil count, IgE, ESR and CRP have limitations as longitudinal biomarkers of disease activity or predictors of flare in EGPA. These findings suggest that novel biomarkers of disease activity for EGPA are needed.
Authors: J H Stone; G S Hoffman; P A Merkel; Y I Min; M L Uhlfelder; D B Hellmann; U Specks; N B Allen; J C Davis; R F Spiera; L H Calabrese; F M Wigley; N Maiden; R M Valente; J L Niles; K H Fye; J W McCune; E W St Clair; R A Luqmani Journal: Arthritis Rheum Date: 2001-04
Authors: R Solans; J A Bosch; C Pérez-Bocanegra; A Selva; P Huguet; J Alijotas; R Orriols; L Armadans; M Vilardell Journal: Rheumatology (Oxford) Date: 2001-07 Impact factor: 7.580
Authors: A T Masi; G G Hunder; J T Lie; B A Michel; D A Bloch; W P Arend; L H Calabrese; S M Edworthy; A S Fauci; R Y Leavitt Journal: Arthritis Rheum Date: 1990-08
Authors: B J Manger; F E Krapf; M Gramatzki; H G Nüsslein; G R Burmester; P B Krauledat; J R Kalden Journal: Scand J Immunol Date: 1985-04 Impact factor: 3.487
Authors: Esha Oommen; Amber Hummel; Lisa Allmannsberger; David Cuthbertson; Simon Carette; Christian Pagnoux; Gary S Hoffman; Dieter E Jenne; Nader A Khalidi; Curry L Koening; Carol A Langford; Carol A McAlear; Larry Moreland; Philip Seo; Antoine Sreih; Steven R Ytterberg; Peter A Merkel; Ulrich Specks; Paul A Monach Journal: Clin Exp Rheumatol Date: 2017-03-01 Impact factor: 4.473
Authors: Alicia Rodriguez-Pla; Roscoe L Warner; David Cuthbertson; Simon Carette; Nader A Khalidi; Curry L Koening; Carol A Langford; Carol A McAlear; Larry W Moreland; Christian Pagnoux; Philip Seo; Ulrich Specks; Antoine G Sreih; Steven R Ytterberg; Kent J Johnson; Peter A Merkel; Paul A Monach Journal: J Rheumatol Date: 2019-09-01 Impact factor: 4.666
Authors: Michael E Wechsler; Praveen Akuthota; David Jayne; Paneez Khoury; Amy Klion; Carol A Langford; Peter A Merkel; Frank Moosig; Ulrich Specks; Maria C Cid; Raashid Luqmani; Judith Brown; Stephen Mallett; Richard Philipson; Steve W Yancey; Jonathan Steinfeld; Peter F Weller; Gerald J Gleich Journal: N Engl J Med Date: 2017-05-18 Impact factor: 91.245
Authors: Christian Dejaco; Bastian Oppl; Paul Monach; David Cuthbertson; Simon Carette; Gary Hoffman; Nader Khalidi; Curry Koening; Carol Langford; Kathleen McKinnon-Maksimowicz; Philip Seo; Ulrich Specks; Steven Ytterberg; Peter A Merkel; Jochen Zwerina Journal: PLoS One Date: 2015-03-26 Impact factor: 3.240