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Is C-reactive Protein an Effective Tool for Measuring Disease Activity in Pediatric Patients with Inflammatory Diseases?

Although high-sensitivity C-reactive protein testing is effective in adult patients when traditional CRP tests do not provide enough information, the high-sensitivity test is not effective for pediatric patients.

Assessment of C-reactive protein (CRP) levels is a standard measurement for determining disease activity in diverse inflammatory disorders, including inflammatory bowel disease (IBD), although a significant number of patients with low CRP levels still present with clinically active disease. When testing of CRP levels is not enough, gastroenterologists can utilize high sensitivity-CRP (hs-CRP) to determine disease activity. New research from a University of Helsinki team in Finland reveals, however, that in pediatric patients, standard CRP tests are not enough to detect active IBD, and, even when hs-CRP is used, it still may not be enough to accurately determine the disease states of pediatric patients.

Pediatric patients with IBD were tested for CRP levels. When these results came back negative, the researchers, led by Marianne Sidoroff, of the Division of Gastroenterology and Endocrinology at the Hospital for Children and Adolescents, University of Helsinki, performed hs-CRP on the children. According to the research team, the results of this test were still not informative enough, as it was unable to “distinguish children with active intestinal inflammation from those with quiescent disease or those responding to glucocorticoid treatment from non-responders.” The ream also reports that “the levels of hs-CRP correlated with the presence of ileal inflammation.”

According to the study published in the World Journal of Gastroenterology, “CRP levels were measured in 39 children with IBD undergoing colonoscopy [median age 12.8 years, Crohn’s disease (CD) n = 20], in 22 other children with IBD followed for acute response to glucocorticoids, and in 33 paediatric non-IBD patients.” The team analyzed hs-CRP levels when standard CRP level was below the detection limit (< 5 mg/L), according to the abstract.

The authors conclude: “the measurement of hs-CRP did not prove useful in the assessment of disease activity or glucocorticoid treatment in pediatric IBD patients that had undetectable standard CRP.”