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Jerome Tanzer, MD

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Shadick et al^1(p2492) have reported that C-reactive protein (CRP) level "was not found to be associated with an increased risk of subsequently developing RA [rheumatoid arthritis]." I would like to offer some thoughts on both the study design and its interpretation.

The study construct presents 2 issues for discussion. First, smoking is known to be a risk factor for clinical RA, possibly by triggering a shared epitope response to autoantigens modified by citrullination,² yet in the study cohort, "women with RA were more likely to be never smokers" (38%) than were those without RA (52%).^1(p2491) The second issue is the apparent lack of screening for statin use.

Statins can dramatically lower CRP values. Their effect is both rapid and significant. In one study examining simvastatin use, CRP level declined from a median of 2.55 mg/L on day 0 to 1.60 mg/L (to convert to nanomoles per liter, . . . [Full Text of this Article]

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RELATED LETTER

C-Reactive Protein Is Still a Potential Aid in Rheumatoid Arthritis Predictors—Reply
Nancy A. Shadick, Elizabeth W. Karlson, and I-Min Lee
Arch Intern Med. 2007;167(14):1552.
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