C-reactive protein and implications in rheumatoid arthritis and associated comorbidities

• Published in: Seminars in arthritis and rheumatism Vol. 51; no. 1; pp. 219 - 229
• Main Authors: Pope, Janet E., Choy, Ernest H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2021
• ISSN: 0049-0172; 1532-866X; 1532-866X
• DOI: 10.1016/j.semarthrit.2020.11.005

•CRP is a valuable marker and regulator of systemic inflammation in RA.•CRP levels appear to be associated with common comorbidities of RA.•CRP appears to play a direct role in bone destruction and disease progression in RA.•Pentameric and monomeric isoforms of CRP have different effects.•Stratification by CRP level in clinical trials may provide valuable information. C-reactive protein (CRP) is routinely assessed as a marker of systemic inflammation in rheumatoid arthritis (RA). However, it is also an immune regulator that plays an important role in inflammatory pathways associated with RA and promotes atherogenic effects. Comorbidities linked to systemic inflammation are common in RA, and CRP has been associated with the risk for cardiovascular disease, diabetes, metabolic syndrome, pulmonary diseases, and depression. The relationship between systemic inflammation, CRP, and comorbidities in RA is complex, and it is challenging to determine how changing CRP levels may affect the risk or progression of these comorbidities. We review the biological role of CRP in RA and its implications for disease activity and treatment response. We also discuss the impact of treatment on CRP levels and whether reducing systemic inflammation and inhibiting CRP-mediated inflammatory pathways may have an impact on conditions commonly comorbid with RA.