Use Of Inflammatory Markers Research Articles

Acute impact of apheresis on oxidized phospholipids in patients with familial hypercholesterolemia

We measured oxidized phospholipids (OxPL), lipoprotein (a) [Lp(a)], and lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) pre- and postapheresis in 18 patients with familial hypercholesterolemia (FH) and with low(∼10 mg/dl; range 10-11 mg/dl), intermediate (∼50 mg/dl; range 30-61 mg/dl), or high (>100 mg/dl; range 78-128 mg/dl) Lp(a) levels. By using enzymatic and immunoassays, the content of OxPL and Lp-PLA(2) mass and activity were quantitated in lipoprotein density fractions plated in microtiter wells, as well as directly on apoB-100, Lp(a), and apoA-I immunocaptured within each fraction (i.e., OxPL/apoB and Lp-PLA(2)/apoB). In whole fractions, OxPL was primarily detected in the Lp(a)-containing fractions, whereas Lp-PLA(2) was primarily detected in the small, dense LDL and light Lp(a) range. In lipoprotein capture assays, OxPL/apoB and OxPL/apo(a) increased proportionally with increasing Lp(a) levels. Lp-PLA(2)/apoB and Lp-PLA(2)/apoA-I levels were highest in the low Lp(a) group but decreased proportionally with increasing Lp(a) levels. Lp-PLA(2)/apo(a) was lowest in patients with low Lp(a) levels and increased proportionally with increasing Lp(a) levels. Apheresis significantly reduced levels of OxPL and Lp-PLA(2) on apoB and Lp(a) (50-75%), particularly in patients with intermediate and high Lp(a) levels. In contrast, apheresis increased Lp-PLA(2)-specific activity (activity/mass ratio) in buoyant LDL fractions. The impact of apheresis on Lp(a), OxPL, and Lp-PLA(2) provides insights into its therapeutic benefits beyond lowering apoB-containing lipoproteins.

Evaluation of a suspected peri-prosthetic infection by joint aspiration using a novel technique

Background: Investigation of a suspected peri-prosthetic infection post joint arthroplasty typically involves an index of clinical suspicion and the use of inflammatory markers, radiological assessment and joint aspiration. Joint aspiration remains the gold standard, but the risk of false positives limits its accuracy. We describe a novel technique of joint aspiration that addresses its inherent shortcomings by limiting the exposure to contamination by skin commensals. Methods: In a laminar airflow theatre, a spinal needle is introduced into the joint space via a truncated 5 ml syringe, (with the plunger removed). The trajectory and position of the advancing spinal needle is confirmed using intermittent anteroposterior (AP) fluoroscopy.Results: The technique described here isolates the aspirating needle and the subsequent sample(s) obtained from the skin flora, thus it also has the advantage of isolating the joint in the same manner. This technique has the added advantages of being simple, cost effective, easy to employ and easy to teach. As it is based on a simple principle it can also be modified for use in prosthetic knee aspirations or in cases where septic arthritis is suspected.Conclusions: Joint aspiration is a useful technique in providing a diagnostic sample to assist in the diagnosis of suspected joint infections. Its sensitivity is affected owing to the risk of sample contamination when obtaining the sample. This technique aims to address the shortcomings of traditional joint aspiration by isolating the aspirating needle and the subsequently obtained sample from the surrounding skin.

Inflammatory markers in coronary heart disease

Inflammation plays a key role in the development of atherosclerosis and coronary heart disease (CHD). Peer-reviewed studies published in English-language journals were reviewed with a focus on C-reactive protein (CRP) and lipoprotein-associated phospholipase A(2) (Lp-PLA2). Elevated levels of serum CRP and Lp-PLA2 are associated with an increased risk of incident CHD events in both primary and secondary prevention studies across a wide range of age, gender and ethnic groups. The utility of inflammatory markers in predicting CHD risk when added to traditional risk factors is under debate. They are most useful in subjects in the intermediate-risk category. Treatment with a statin in subjects with elevated CRP but without hyperlipidemia can reduce the risk of CHD. Extensive research is under way to identify additional novel serum markers with higher specificity for coronary artery plaque inflammation. Specific inhibitors against vascular inflammation in combination with medications to lower low-density lipoprotein cholesterol, i.e. statins, may help prevent cardiovascular events in the future.

Initial Management of Fever and Neutropenia in a Child With Cancer—The Past, the Present, and the Future

Fever in a patient with an underlying malignancy who has neutropenia is a relatively common event that requires urgent attention because of the risk of associated morbidity and mortality. Although a clinically suspected or microbiologically documented bacterial infection is present in up to half of such febrile neutropenia episodes, an etiology is not identified in the rest. In a neutropenic patient, signs and symptoms of inflammation can be blunted or atypical, and infections may progress unnoticed, resulting in a life-threatening complication. Often, fever is the only manifestation of infection. For these reasons, empirical intravenous broad-spectrum antibiotics in an inpatient setting have long been the mainstay of treatment for febrile neutropenic patients. However, not all febrile neutropenic patients are at the same risk for developing infection-related complications. Addressing this variability in associated risk, risk-stratified management approaches have been suggested to minimize hospital stay, improve patients' quality of life, and decrease related health care costs. This article reviews some guiding principles of initial management of febrile neutropenic children with cancer with a focus on risk-stratified treatment approaches, including the use of inflammatory markers to discern risk.

Use of Inflammatory Markers to Guide Cancer Treatment

Patient-related factors, especially markers of inflammatory response, are prognostic in many common solid cancers. Here we review how such markers, in particular the acute-phase proteins C-reactive protein and albumin and a differential white cell count, can predict treatment outcomes in cancer patients. The review examines the literature pertaining to surgery, chemotherapy, and radiotherapy and discusses how inflammatory markers might be incorporated into the planning and monitoring of cancer treatments. Clinical Pharmacology & Therapeutics (2011) 90 3, 475–478. doi:10.1038/clpt.2011.122

Differential Effects of Zinc in Severe Pneumonia in Children

We read with great interest the article by Bansal et al. [1]. The authors had conducted a clinical trial and found that, zinc supplementation did not reduce recovery time and duration of hospital stay in children with severe acute lower respiratory tract infection (ALRTI). The study is well described, but there are few points that need comment. The authors describe that; zincmay bemore effective in the treatment of serious bacterial pneumonias, and not in viral pneumonias or bronchiolitis, which are predominantly viral illnesses. In their study, the percentage of children with wheezing was quite high (68.5%), and though they analyzed the outcome measures for wheezy and non-wheezy children separately, they did not find any significant difference in outcome. Actually, there is no published study examining the role of zinc in severe bacterial versus viral pneumonia. So, these are all speculations that zinc does not help children with pneumonia due to viral etiology (based on proportion of children with wheezing). If we look at the mechanism, how zinc might be beneficial in pneumonia, the following points need mention. Zinc deficiency enhances airway inflammation and cellular damage, whereas zinc supplementation might protect the lung from inflammatory states. Mechanisms for anti-inflammatory action of zinc in the respiratory tract include: blocking the binding of leucocytes to the endothelial cells via interaction between intercellular adhesion molecule (ICAM) -1 and leucocyte associated antigen-1 [2], inhibiting the release of preformed mediators from inflammatory cells, etc. So, the beneficial effects of zinc in severe pneumonia might depend upon the extent of inflammation and its resolution rate, as well as on the acute phase response mediated by the cytokines. Zinc also has potent antiviral action that includes: prevents the formation of viral capsid proteins (inhibiting in vitro replication of viruses) [3], prevents the virus from combining with the ICAM-1 (inhibiting viral entry into the cell), may induce the production of interferon (having non-specific antiviral actions) [4], inhibit human prostaglandin metabolism (thus decreasing inflammation). So, there is no reason for the differential effects of zinc in severe pneumonia according to the etiology. If this is proved, zinc may find its place in management of severe pneumonia as in acute diarrhea. We hope that, future trials should focus on this issue and try to compare the differential effects of zinc in severe bacterial and viral pneumonia. This might be difficult, but some suggestions include: use of chest radiograph in addition to clinical definition of pneumonia, designing the studies in a way to detect the difference in the subgroup of children without wheezing or totally excluding wheezing children, microbiological criteria (culture, PCR, antigen and/or antibody detection, etc), use of inflammatory markers (C reactive protein, procalcitonin), etc.

Routine use of inflammatory markers in paediatric inflammatory bowel disease

IntroductionRoutine blood investigations are regularly performed in secondary and tertiary care to aid in predicting the presence or absence of intestinal inflammation. There is a need for laboratory costs and...

The use of inflammatory markers as a method for discharging patients post hip or knee arthroplasty

Complications after orthopaedic surgery have a substantial impact on resources, including the financial resources of the health-care system. Early detection of patients developing complications, thus excluding those patients without complications should have a major impact on patients' management. We evaluated the prognostic value of blood levels of inflammatory markers (interleukin-6, C-reactive protein, total white blood cell count) for complications after primary hip and knee arthroplasty in a routine setting, and their impact on patient management. First, the three inflammatory markers were evaluated in 68 consecutive patients treated at the Department of Orthopaedics. Laboratory markers were measured on days 2 and 4 after surgery. Second, patient management before and after adapting the routine order for laboratory parameters after arthroplasty were evaluated. We could show that interleukin-6 and the C-reactive protein had an almost equal negative predictive value for the exclusion of postsurgical complications. Nevertheless, interleukin-6 returned below its reference levels almost 2 days earlier compared to the other markers. This made an earlier discharge of patients with presumable complications-less postsurgical process possible. So, the total number of patients treated as well as the financial reimbursement could be increased and concurrently occupancy days and averaged length of stay were reduced.

Inflammation, immunological reaction and role of infection in pulmonary hypertension

Inflammation underlies a wide variety of physiological and pathological processes. Acute inflammation is the initial response of the body to harmful stimuli. Chronic inflammation, by contrast, is a prolonged, dysregulated and maladaptive response that involves active inflammation, tissue destruction and attempts at tissue repair. Over the past few years, such persistent inflammation has been shown to be associated with pulmonary hypertension (PH). Substantial advances in basic and experimental science have illuminated the role of inflammation and the underlying cellular and molecular mechanisms that contribute to PH. This review summarizes the experimental and clinical evidence for inflammation in various types of PH. In addition, it assesses the current state of knowledge regarding the inducers/triggers of chronic inflammation and infection, as well as the inflammatory mediators and cells that are involved in PH. Infiltration of inflammatory cells, such as dendritic cells, macrophages, mast cells, T-lymphocytes and B-lymphocytes, in the vascular lesions and an elevation of serum/tissue concentrations of proinflammatory cytokines and chemokines and their contribution to pulmonary vascular remodelling are reported in detail. We review the data supporting the use of inflammatory markers as prognostic and predictive factors in PH. Finally, we consider how new insights into inflammation in PH may identify innovative therapeutic strategies.

The clinical use of inflammatory markers during pregnancy

There is overwhelming evidence that intrauterine infection and inflammation play an important role in the pathogenesis of spontaneous preterm labor, preterm prelabor rupture of the membranes and fetal injury resulting in long-term sequelae. Early diagnosis of subclinical infection and inflammation may therefore aid clinicians institute interventions focusing on such adverse outcomes. Biomarkers of intrauterine inflammation such as interleukin-6, although sensitive, are not specific. Thus, decision to deliver remote from term because of intrauterine infection and/or inflammation should be based on clinical signs and/or bacterial culture or Gram stain of amniotic fluid. In patients with preterm contractions and intact membranes, the risk of delivery is 1% within the week following a negative fetal fibronectin in cervicovaginal secretions. This aids to decide whether antenatal steroids should be administered to patients presenting with preterm contractions between 24 and 34 weeks' gestation. Biomarkers in cervical secretions and amniotic fluid identify those who may benefit from cerclage when the cervix is shortened (<25 mm) and dilated in the second trimester. So far, few interventions utilizing inflammatory biomarkers have shown clinical benefit. Future efforts should focus on the quest for accurate biomarkers that can be obtained noninvasively and allow early prediction of subclinical disease to initiate appropriate risk-specific intervention.

Predictive Markers of Blood Cytokine and Chemokine in Recurrent Brain Infarction

The mechanism of the inflammatory response in the vascular wall in atherothrombosis and during the progression of atherosclerosis has attracted attention. We focused on the potential usefulness of inflammatory markers in chronic recurrent brain infarction, and analyzed the role of inflammatory markers in atherosclerosis of the intracranial artery. The subjects were 2 groups of patients treated between 2004 and 2006: a group of outpatients with recurrent infarction (group RI), who developed atherothrombotic brain infarction twice; another group of outpatients with brain infarction without recurrence (group BI), who developed brain infarction once and remained free of recurrence for >1 year; and a group of control subjects with normal brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) (group C). Plasma samples were collected from each group of patients for the simultaneous measurement of 17 kinds of candidate inflammatory markers, using a fluorescent microbead array system, and the results were compared with head MRA findings. The levels of high-sensitivity C-reactive protein (hsCRP) and monocyte chemoattractant protein-1 (MCP-1) were significantly higher in group RI patients than in groups C and BI. Subjects with a hsCRP level > or =0.3 and a MCP-1 level > or =200 in the serum have, respectively, a 1.92 and 2.98 relative risk to have a potential recurrent infarction. Regarding the relation of inflammatory marker levels with MRA findings, group RI showed significantly higher levels of hsCRP at M1 lesions and MCP-1 at A1 and M1 lesions than group BI (P < 0.05). In conclusion, the MCP-1 level as well as hsCRP in the blood can be a potential predictive marker of recurrent thrombotic brain infarction, and may reflect inflammation that promotes intracranial large-artery atherosclerosis.

Síndrome del intestino irritable y enfermedad inflamatoria intestinal: ¿alguna conexión?

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders and is that with the greatest socioeconomic impact worldwide. Diagnosis of IBS is based on clinical criteria that have been modified over time, the Rome II criteria being those that are currently followed. Some of the symptoms of IBS are similar to those in patients with inflammatory bowel disease (IBD), which can hamper or delay diagnosis. The use of inflammatory markers in stools (such as calprotectin) may help to distinguish between these two entities. A possible connection between IBS and IBD could be based on five points: (i) both disorders have similar symptoms; (ii) symptoms often overlap in the same patients; (iii) IBS and IBD have a common familial aggregation; (iv) some predisposing factors, such as a history of acute gastroenteritis, play a role in both disorders, and (v) importantly, signs of microinflammation are found in the bowels of patients with IBS. With regard to this latter point, an increase in inflammatory cells has been found in the intestinal mucosa of patients with IBS and, more specifically, mastocytes have been found to be increased in the jejunum and colon while CD3 and CD25 intraepithelial lymphocytes have be observed to be increased in the colon. Moreover, activated mastocytes are increased near to nerve endings in patients with IBS and this finding has been correlated with the intensity of both intestinal symptoms (abdominal pain) and psychological symptoms (depression and fatigue). A good model of microinflammation is post-infectious IBS, since the timing of the onset of the infectious process is known. In patients with post-infectious IBS, an increase in intraepithelial lymphocytes and enterochromaffin cells is initially found, which is reduced over time; consequently, although the symptoms of IBS persist, after 3 years no differences are detected in the number of inflammatory cells between IBS patients and controls. Among the various factors that can favor the development of IBS in these patients, two host-dependent mechanisms are most closely implicated in the physiopathology of IBS: polymorphism of the genes codifying pro- or anti-inflammatory cytokines and psychological factors such as anxiety, depression, somatization and neuroticism at the time of the acute infection. In view of all of the above, the similarities between IBS and IBD are probably more than mere coincidence and may reflect distinct manifestations of a broad spectrum of inflammation in the colon.

Marcadores inflamatórios da doença cardiovascular em idosos

Most information on the role of inflammatory markers as cardiovascular disease predictors concerns only middle-aged individuals. This review aims at evaluating the role of inflammatory markers as cardiovascular disease predictors in the elderly. The Medline (Pubmed) and Cochrane databases were used in the search, using the key words. After adding the following filters:Aged 65+ years, Humans, Randomized Controlled Trial, Meta-Analysis, Review, Clinical Trials, 554 studies were identified. Of these, 120 were selected and evaluated regarding their power of evidence (classification of the Oxford Centre for Evidence-Based Medicine). In studies with patients older than 65 years, interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) showed to be good predictors of cardiovascular events. Regarding C-reactive protein (CRP), the data are inconsistent, as it appears to have lower power of prediction in the elderly when compared to middle-aged individuals. Fibrinogen levels seem to be predictors of mortality, although they are non-specific predictors, i.e., not solely of cardiovascular mortality. Additionally, the inflammatory markers are also indicative of functional decline and mortality, regardless of the presence of cardiovascular disease. The current evidence is not sufficient to allow the routine use of inflammatory markers in the elderly, as there are few studies in this age range and most of them are short-term ones with a small number of inflammatory markers. The routine request for these markers must be decided on an individual basis.

Assessing asthma control: questionnaires and exhaled nitric oxide provide complementary information

To the Editor: Current asthma guidelines propose the use of quantitative composite measures of asthma control for assessment and follow-up 1. The use of inflammatory markers within the definition of control in asthma guidelines has been recently suggested 2. Sputum eosinophilia has been proposed as a useful surrogate marker of airway inflammation 3 but it is time-consuming and unfeasible in many clinical settings. In contrast, exhaled nitric oxide fraction ( F eNO) is easily measured, well correlated with eosinophilic airway inflammation 4 and has been used in routine asthma care 5. However, to be included in the assessment of asthma control it should provide additional information. Factor analysis is a statistical method used to uncover which sets of variables form coherent subsets that are relatively independent of one another, and to obtain a small number of factors …

Septic arthritis: clinical audits would help optimise the management

We audited management of septic arthritis (SA) in our institution comparing them with the British Society for Rheumatology (BSR) guidelines and also ascertained awareness regarding these guidelines among trainee doctors. All adult patients who were admitted to our institution between January 2005 and December 2006 with symptoms and signs of SA and had positive synovial fluid culture were included, and a structured proforma was used to extract the relevant information from the case notes and laboratory tests. Management of 21 patients with SA was audited. In several areas (such as appropriate samples for cultures prior to initiation of antibiotics and use of inflammatory markers in monitoring the response to treatment), management of both native and prosthetic joint SA fell short of compliance with the BSR guidelines. A total of 58% trainee doctors surveyed were unaware of these guidelines. Our audit identified deficiencies in standards of care of SA. Lack of awareness regarding these guidelines contributes to the suboptimal care of patients with SA. Wider dissemination of the BSR guidelines with similar audits being a starting point would help in optimising the management of SA.

Consensus Panel Recommendation for Incorporating Lipoprotein-Associated Phospholipase A 2 Testing into Cardiovascular Disease Risk Assessment Guidelines

A consensus panel was formed to review the rapidly emerging literature on the vascular-specific inflammatory marker lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) and to update recommendations for the appropriate use of this novel biomarker in clinical practice. The recommendations of the panel build on guidelines of the Adult Treatment Panel III (ATP III) and the American Heart Association/Centers for Disease Control (AHA/CDC) for cardiovascular risk assessment. Consistent with the ATP III guideline recommendations for the use of inflammatory markers, Lp-PLA(2) is recommended as an adjunct to traditional risk assessment in patients at moderate and high 10-year risk. A simplified framework for traditional Framingham risk factor assessment is proposed. As a highly specific biomarker for vascular inflammation, elevated Lp-PLA(2) levels should prompt consideration of increasing the cardiovascular risk category from moderate to high or high to very high risk, respectively. Because intensification of lifestyle changes and low-density lipoprotein (LDL) cholesterol lowering is beneficial in high-risk patients, regardless of baseline LDL cholesterol levels, consideration should be given to lowering the LDL cholesterol target by 30 mg/dL (1 mg/dL = 0.02586 mmol/L) in patients with high levels of Lp-PLA(2). Lp-PLA(2) is recommended as a diagnostic test for vascular inflammation to better identify patients at high or very high risk who will benefit from intensification of lipid-modifying therapies. However, at this time Lp-PLA(2) cannot be recommended as a target of therapy.

Usefulness of Laboratory Data in the Management of Right Iliac Fossa Pain in Adults

This study examined the usefulness of inflammatory markers in the management of patients with right iliac fossa pain. A single site, prospective observational study was conducted from October 2001 to April 2003. Patients with right iliac fossa pain referred to the surgeon were included. Blood samples were obtained for C-reactive protein, leukocyte, and granulocyte analysis. Clinical, surgical, and histopathologic data were collected. Analysis of inflammatory parameters was performed with logistic regression and areas under the receiver operating characteristic curve were compared. C-reactive protein increased with the severity of appendicitis and predicted accurately perforation (r(2) = 0.613; P < 0.0005), showing the highest accuracy among inflammatory markers (areas under the receiver operating characteristics curve were 0.846, 0.753, and 0.685 for C-reactive protein, leukocyte and granulocytes, respectively; P < 0.001). Accuracy improved when C-reactive protein and leukocytes were combined; positive and negative predictive values were 93.2 percent and 92.3 percent, respectively. C-reactive protein is a helpful marker in the management of patients with right iliac fossa pain; the predictive value improves when combined with leukocyte count. A patient with normal C-reactive protein and leukocytes has a very low probability of appendicitis and should not undergo surgery.

Benchmarks for the Assessment of Novel Cardiovascular Biomarkers

The investigation of novel circulating serum and plasma biomarkers in patients with cardiovascular disease has been accelerating at a remarkable pace. For example, a Medline search that uses the terms “biomarkers” and “acute coronary syndromes” (ACS) reveals an approximate tripling in the number of published reports during the 2-year interval from 2003 to 2004 compared with the period from 2001 to 2002, and this number more than doubled from 2005 to 2006. Although this expanding body of research has established firm evidence for the value of biomarkers, such as for diagnosis and risk assessment among patients with suspected ACS,1 it has also deluged the clinical and research communities with candidate biomarkers, very few of which are likely to survive the test of time as useful clinical tools.2,3 It is thus increasingly important for researchers, manufacturers, regulators, and clinicians to critically appraise the value of new biomarkers as they emerge as candidates for further investigation and possible clinical application. The superb report by Wollert and colleagues4 in the present issue of Circulation on growth differentiation factor-15 (GDF-15) as a biomarker for prognostic assessment in ACS provides an opportunity to outline a basic set of benchmarks against which new markers can be evaluated. Article p 962 Assessment of the clinical potential of a novel biomarker5 may be structured around 3 fundamental questions (Figure): (1) Can the clinician measure it? (2) Does it add new information? (3) Does it help the clinician to manage patients? A, Criteria for assessment of novel cardiovascular biomarkers for clinical use. Statements in bold font are given the highest priority. B, Clinical applications of cardiovascular biomarkers. To be clinically useful, analytical methods must be available that allow reliable measurement, optimally with capability for high throughput tests, prompt turnaround time, and reasonable cost. Evaluation of …

Inflammatory Biomarkers in Heart Failure

Multiple lines of evidence support the "cytokine hypothesis," which suggests that inflammation plays an important role in the development and progression of heart failure. Circulating markers of inflammation, such as tumor necrosis factor alpha, interleukin 6, and C-reactive protein, may be useful in establishing the diagnosis, gauging prognosis, and evaluating the response to therapy in patients with heart failure. In addition to their potential as heart failure biomarkers, inflammatory cytokines have been investigated as targets of heart failure therapy. Although results for therapies directed against specific cytokines (such as tumor necrosis factor alpha) have thus far been disappointing, multiple studies continue to address the therapeutic potential of modulating the immune response in heart failure. In this review, the authors analyze available data supporting the use of inflammatory markers both as biomarkers and as potential therapeutic targets.

Diagnostic Usefulness of Inflammatory Markers in Acute Cellular Rejection After Heart Transplantation

Background Acute cellular rejection (ACR) affects early morbidity and mortality after heart transplantation. The diagnostic technique of choice is endomyocardial biopsy. Our aim was to evaluate the diagnostic usefulness of inflammatory markers as a noninvasive method to monitor cellular rejection. Material and Methods We prospectively analyzed 73 cardiac transplant patients by determining the serum levels of protein fibrinogen (fgpro), functional fibrinogen (fgfun), C-reactive protein (CRP), and sialic acid (SA) coinciding with an endomyocardial biopsy (5.1 revisions/patient). The statistical methods were χ 2, Student’s t-test, and ROC curves. Results Of the 373 controls, significant rejection was detected in 19%. Analysis of the relationship between ACR and the markers showed significantly elevated levels of fgpro (345 ± 90 versus 307 ± 74 mg/dL; P = .03), fgfun (361 ± 101 versus 318 ± 89 mg/dL; P = .04), and SA (74 ± 22 versus 66 ± 15 mg/dL; P = .02), but not CRP (19 ± 29 versus 10 ± 21 mg/dL; P = .07). SA displayed a better diagnostic utility (area under the curve 0.7; P < .01), 35% sensitivity, 85% specificity, and 82% negative predictive value for a cutoff point of 80 mg/dL. Conclusions Among the inflammatory markers increased in ACR, SA was the most useful noninvasive tool for screening.