Friday, November 23, 2012

Plasma Fibrinogen and Polymyalgia Rheumatica

There has been an interesting observational study on polymaylgia rheumatica at the ACR 2012 meeting in Washington. E.M. McCarthy and colleagues looked at 120 patients with polymyalgia rheumatica. Tailoring glucocorticoids is always a problem, but especially in patients with polymyalgia rheumatica. If you start with a very high glucocorticoid dosage and tailor too slowly then you risk adverse events like treatment related osteoporosis. If you start too low and tailor too quickly you risk incomplete control of disease activity, disability, and a prolonged treatment, also resulting in treatment related side effects. The authors looked into a better marker for disease activity and found plasma fibrinogen to be this marker. The results of this study are so convincing that I’ll test for fibrinogen in the future.

No. 2348
EM McCarthy, Paul A. MacMullan, S. Al-Mudhaffer , Anne M. Madigan, S. Donnelly, C. J. McCarthy, Dermot Kenny, Eamonn S. Molloy and G M. McCarthy:
Plasma Fibrinogen Better Identifies Persistent Disease Activity in Polymyalgia
Rheumatica Than Either ESR or CRP.
                 Specificity Sensitivity Likelihood ratio
Fibrinogen      96%        34%            8.20          P_.002
CRP                67%        68%            2.04          P_.004
ESR                75%        43%            1.70          P_.16
Conclusion: “Elevated plasma fibrinogen more accurately indicates that patients have persistent disease activity than either the ESR or CRP. Measurement of fibrinogen may therefore help treating physicians more accurately identify patients’ disease status and guide decisions with regards to glucocorticoid dosage.”

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