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Legger GE, Dermer CWE, Brunger AF, van Daele PLA, Nienhuis HLA. The relation between C-reactive protein and serum amyloid A in patients with autoinflammatory diseases. Pediatr Rheumatol Online J 2022; 20:106. [PMID: 36434581 PMCID: PMC9700917 DOI: 10.1186/s12969-022-00757-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/29/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Autoinflammatory diseases are rare disorders of the innate immune system characterized by fever and other signs of inflammation. A feared complication of autoinflammatory diseases is the development of AA amyloidosis. AA amyloidosis is caused by extracellular deposition of soluble serum amyloid A (SAA) proteins as insoluble amyloid fibrils leading to organ damage. Prolonged high levels of SAA are a prerequisite to develop AA amyloidosis. Since measurement of SAA is relatively expensive and sometimes unavailable, C-reactive protein (CRP) is often used as a surrogacy marker to test for inflammation. OBJECTIVE The aim of this research is to evaluate the possible relation between CRP and SAA. METHODS A retrospective cohort of patients with autoinflammatory diseases (n = 99) where SAA and CRP blood testing was performed in the period between 2015 and 2021 in the University Medical Centre in Groningen was used to investigate the correlation between CRP and SAA. RESULTS CRP and SAA have a high correlation (rho = 0.755, p < 0.001). A CRP value below 0.45 mg/L results in 100% sensitivity for SAA below 4 mg/L. CRP below 5 mg/L is a good predictor of SAA below 4 mg/L with 85.4% sensitivity and 83.6% specificity. Only prednisone and erythrocyte sedimentation rate (ESR) significantly influence the relation between CRP and log10SAA. CONCLUSION There was a significant correlation between CRP and SAA in our retrospective cohort. CRP levels below 5 mg/L proved to be highly predictive of SAA levels below 4 mg/L. This may not be true for patients on steroids.
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Affiliation(s)
- G. E. Legger
- grid.4494.d0000 0000 9558 4598Department of Pediatric Rheumatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C. W. E. Dermer
- grid.4494.d0000 0000 9558 4598Department of Pediatric Rheumatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A. F. Brunger
- grid.4494.d0000 0000 9558 4598Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P. L. A. van Daele
- grid.5645.2000000040459992XDepartment of Internal medicine, section allergy and clinical Immunology, Erasmus University, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H. L. A. Nienhuis
- grid.4494.d0000 0000 9558 4598Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Luck ME, Tao J, Lake EP. The Skin and Gut Microbiome in Hidradenitis Suppurativa: Current Understanding and Future Considerations for Research and Treatment. Am J Clin Dermatol 2022; 23:841-852. [DOI: 10.1007/s40257-022-00724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/30/2022]
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Andriano TM, Benesh G, Babbush KM, Hosgood HD, Lin J, Cohen SR. Serum inflammatory markers and leukocyte profiles accurately describe hidradenitis suppurativa disease severity. Int J Dermatol 2022; 61:1270-1275. [PMID: 35543428 DOI: 10.1111/ijd.16244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/28/2022] [Accepted: 04/19/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Inflammatory markers and leukocyte profiles have not been longitudinally evaluated as objective signs of hidradenitis suppurativa (HS) severity. We sought to assess C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), and leukocyte profiles as reliable indicators of HS severity. METHODS Retrospective cohort study of 404 patients seen at the Einstein/Montefiore HS Center, Bronx, New York, between March 2019 and November 2020. Associations of disease severity (HS-Physician Global Assessment) with inflammatory markers and leukocyte profiles were assessed by odds ratios (OR) and 95% confidence intervals (95% CI) incorporating up to four visits per patient, adjusting for baseline gender, age, BMI, and smoking status. RESULTS Patients with severe disease had elevated CRP (OR 1.87; 95% CI 1.49, 2.34), ESR (OR 1.04; 95% CI 1.03, 1.04), IL-6 (OR 1.08; 95% CI 1.00, 1.16), leukocytes (OR 1.22; 95% CI 1.14, 1.31), neutrophils (OR 1.31; 95% CI 1.20, 1.42), eosinophils (OR 14.40; 95% CI 2.97, 69.74), basophils (OR 2.53; 95% CI 1.09, 5.85), monocytes (OR 5.36; 95% CI 2.49, 11.53), and neutrophil-lymphocyte ratios (OR 1.63; 95% CI 1.35, 1.96) but decreased lymphocytes (OR 0.86; 95% CI 0.68, 1.10). CONCLUSIONS This novel longitudinal study of inflammatory markers and leukocyte profiles offers critical laboratory measures to confirm clinically determined disease severity over time.
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Affiliation(s)
- Tyler M Andriano
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Gabrielle Benesh
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Kayla M Babbush
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - H Dean Hosgood
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juan Lin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Steven R Cohen
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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Okeke CAV, Williams JP, Iwuala CU, Igwe PK, Khanna R, Perry JD, Okoye GA, Byrd AS. What's Race Got to Do With It? CRP Levels in Immune Mediated Skin Diseases: Considerations for Hidradenitis Suppurativa. Front Immunol 2022; 13:847050. [PMID: 35432388 PMCID: PMC9009384 DOI: 10.3389/fimmu.2022.847050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/28/2022] [Indexed: 01/08/2023] Open
Abstract
Currently, there is a lack of racial/ethnic heterogeneity in research databases, exposing a systematic issue in studies exploring inflammation-mediated diseases, such as hidradenitis suppurativa (HS). HS is a chronic inflammatory skin condition that disrupts normal structure and functioning of terminal hair follicles, resulting in the formation of recurrent abscesses, nodules, and sinus tracts within intertriginous regions. Studies have described higher serum levels of inflammation-mediated C-reactive protein (CRP) in patients with HS, a disease that predominantly affects skin of color (SOC) populations. Herein, we explore the role of CRP levels in the context of HS disease presentation, management, and psychosocial implications in SOC patients to determine existing disparities in research studies.
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Affiliation(s)
| | | | - Callyn U Iwuala
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Pearl K Igwe
- Howard University College of Medicine, Washington, DC, United States
| | - Raveena Khanna
- Department of Psychiatry, Creighton University School of Medicine, Phoenix, AZ, United States
| | - Jessica D Perry
- Howard University College of Medicine, Washington, DC, United States
| | - Ginette A Okoye
- Department of Dermatology, Howard University College of Medicine, Washington, DC, United States
| | - Angel S Byrd
- Department of Dermatology, Howard University College of Medicine, Washington, DC, United States
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Der Sarkissian S, Hessam S, Kirby JS, Lowes MA, Mintoff D, Naik HB, Ring HC, Suyien NC, Frew JW. Identification of Biomarkers and Critical Evaluation of Biomarker Validation in Hidradenitis Suppurativa: A Systematic Review. JAMA Dermatol 2022; 158:300-313. [PMID: 35044423 DOI: 10.1001/jamadermatol.2021.4926] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance The identification and validation of biomarkers in hidradenitis suppurativa (HS) has potential to improve the understanding and management of this chronic, burdensome disease. Objective To systematically identify all known HS biomarkers, categorize them by biomarker type, and critically evaluate their validity according to established criteria. Evidence Review Eligibility criteria for this review (PROSPERO Registration 230830) included randomized clinical trials, uncontrolled clinical trials, cohort studies, case-control studies, and other observational studies with no restrictions of patient age, sex, race or ethnicity, or language of publication up until December 31, 2020. All articles were categorized into biomarker type, defined using the US Food and Drug Administration Biomarkers, Endpoints, and other Tools (BEST) glossary. Assessment of each identified biomarker was undertaken in line with the US Food and Drug Administration and European Medicines Agency guidelines for the validation of proposed biomarkers. Assessment of the strength of overall data regarding individual biomarkers was undertaken using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Findings A total of 3953 nonduplicate articles were screened, of which 1429 articles were retrieved based on the include/exclusion criteria applied. After full-text screen and data extraction, 106 articles were included in this review. The evidence of strength of 6 categories of biomarkers (susceptibility/risk, diagnostic, monitoring, predictive, prognostic, and pharmacodynamic/response biomarkers) was assessed using GRADE criteria. A total of 48 biomarkers were identified with a minimum GRADE rating of moderate. Only 1 diagnostic (serum IL-2R), 1 monitoring (dermal Doppler vascularity), and 2 predictive biomarkers (epithelialized tunnels and positive family history of HS) achieved a GRADE rating of high. None of the identified biomarkers had sufficient clinical validity to be recommended for routine use in the clinical setting. Conclusions and Relevance Major barriers to the identification, validation, and introduction of routine biomarkers in the management of HS include lack of independent biomarker validation studies (especially assumption-free "omics"-based techniques); insufficient assessment of collinearity between identified or proposed biomarkers; and a lack of routine integration of biomarkers into the structure of clinical trials. International consensus among researchers, clinicians, and pharmaceutical stakeholders is required to standardize goals and methods and encourage biomarker integration into future HS clinical trials. This systematic review presents a number of priorities for near-term future research to overcome such barriers and limitations of biomarkers in HS.
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Affiliation(s)
| | - Schapoor Hessam
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Dillon Mintoff
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - Haley B Naik
- Department of Dermatology, University of California San Francisco.,Associate Editor, JAMA Dermatology
| | - Hans Christian Ring
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nisha Chandran Suyien
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,University of New South Wales, Sydney, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Sydney, Australia
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6
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Questions about data: Importance of serum amyloid A level in patients with multiple sclerosis. J Neuroimmunol 2021; 353:577516. [PMID: 33581665 DOI: 10.1016/j.jneuroim.2021.577516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
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Karvar M, Panayi AC, Alavi A, Baziar Z, Orgill DP. Trends in the management of hidradenitis suppurativa in the Middle East region: a systematic review. Int J Dermatol 2020; 60:e440-e448. [PMID: 33615455 DOI: 10.1111/ijd.15293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, painful, and severely debilitating inflammatory disease that affects apocrine gland-bearing skin. There is no universal consensus on the management of hidradenitis suppurativa (HS). Current available guidelines are from western countries, which may be of limited use in other parts of the world. In this study, we aim to identify trends in the management of HS in the Middle East (ME) and its differences with the West. METHODS A systematic literature review was performed to identify all studies in HS management performed by experts in the ME from database inception to June 2020 using PubMed, EMBASE, and Cochrane Library databases. Only original articles published in English language were included. Guidelines from western countries were used for comparison. RESULTS Fifty-four eligible studies comprising 7649 HS patients from the ME region and nine guidelines from the West were included. No established guidelines were found for the management of HS in the ME. Sex ratio of HS patients in the ME is different in that men reported to be affected at a higher rate than in the West. Different antibiotic regimens were recommended in the ME, and the experts in the ME tend to be more procedure intensive than experts in the West. CONCLUSIONS Establishing a guideline for HS management in the ME is recommended to address unique considerations in the countries in this region.
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Affiliation(s)
- Mehran Karvar
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Adriana C Panayi
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Afsaneh Alavi
- Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Zahra Baziar
- Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dennis P Orgill
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
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