Background/Purpose:

Familial Mediterranean Fever (FMF) is an autoinflammatory disease characterized by recurrent inflammatory attacks. Attacks are accompanied by substantial increase in acute phase reactants such as C-reactive protein (CRP) and serum amyloid A (SAA) which usually decrease once the attack subsides. CRP and SAA have been considered as the most sensitive acute phase markers. We aimed to compare the behaviour of SAA and CRP in four different clinical conditions, in order to evaluate their role and possible differences during the course of FMF. Here we report our preliminary results on SAA and CRP response in a group of patients with FMF, sepsis, appendicitis and healthy controls.

Methods:

Our study has a prospective design and is performed in a single institution. Blood samples were drawn from 15 FMF patients during attacks and control samples were obtained once the attacks subsided. We also included 17 patients with acute appendicitis and samples were drawn before and after the appendectomy. We also included 43 cases with sepsis. Among these 43, serial blood testing was performed for 19 cases. We also included 20 healthy controls without a proven medical condition. Serum CRP levels were measured via Enzyme Immunoassay (ELISA) method. Cut-off level was determined as 8 mg/L. Results were given as x-folds of normal. Serum Amyloid A levels were measured by using nephelometric method. Cut-off level was determined as 6.8 mg/L.

Results:During the FMF attack, mean SAA level was 50±34,96, whereas it was 0,92±1,10 during the attack-free period (p<0.01). CRP was also decreased from 26,32 ± 13,9 to 3,61 ± 2,67 once the attacks subsided (p<0.01). For the group with acute appendicitis, preoperative and postoperative mean SAA levels were 51,70 ± 63,09 and 0,82 ± 0,89, respectively (p<0.001). For this group, mean CRP was also decreased following the operation from 21,75 ± 12,47 to 3,31 ± 3,40 (p<0.01). In sepsis group mean SAA and CRP levels were 43,42 ± 40,92 and 27,92 ± 12,23, respectively. Whereas in healthy controls mean SAA level was 0,63 ± 0,25, while mean CRP level was 0,53 ± 0,2. With regards to the correlation between SAA and CRP, analysis was performed for each setting. In FMF group, SAA and CRP were correlated both during and after the attacks (r=0.806, p<0.001). Also in acute appendicitis group, CRP and SAA were positively correlated (r=0.877, p<0.001) both preoperatively and postoperatively. In addition to the finding that CRP and SAA were also positively correlated in sepsis group (r=0.278, p=0.012), for the 19 sepsis cases in which serial measures were performed, this correlation was sustained for three consecutive days (r=0.610, p=009; r=0.596, p=0.012; r=0.574, p=0.016; day 1, 2 and 3, respectively).

Conclusion: We report that, SAA and CRP levels were correlated in various disease settings. Given the fact that, none of our patients had higher than normal SAA levels despite normal CRP, these two markers seem to have, if any, only minute behavioural differences when it comes to following an FMF case in clinical practice. Although our results are grounded on our preliminary data, both CRP and SAA seem to be effective and efficient to follow a case with FMF.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/c-reactive-protein-and-serum-amyloid-a-in-sepsis-acute-appendicitis-and-familial-mediterranean-fever/