C-reactive protein (CRP) is used to assess disease activity in diverse inflammatory disorders including inflammatory bowel disease (IBD). However, in IBD, a significant number of patients present with low CRP levels despite clinically active disease. In paediatric patients with IBD the performance of CRP is an understudied area. High-sensitivity CRP (hs-CRP) measures CRP levels that were previously thought to be under the detection limit. In paediatric IBD, this kind of highly sensitive marker is needed for the detection of the presence of inflammation.
A research team from Finland investigated the association between hs- CRP and clinical and histological activity in paediatric IBD patients, and evaluated the effect of glucocorticoid treatment on the hs-CRP levels. Their study will be published on June 21, 2010 in the World Journal of Gastroenterology.
The results showed that standard CRP test is negative in a considerable number of paediatric patients with active IBD and the routine measurement of CRP is thus not informative enough. Hs-CRP detects low levels of CRP but disappointingly it does not help to distinguish children with active intestinal inflammation from those with quiescent disease or those responding to glucocorticoid treatment from non-responders. Interestingly, the levels of hs-CRP correlated with the presence of ileal inflammation.
This research reinforces the concept that a significant number of paediatric patients with active IBD may present with CRP levels that are under the detection limit. Hs-CRP instead, was detectable in all the patients. Unfortunately, in this pilot study the measurement of hs-CRP levels in the patients that had undetectable standard CRP levels could not stratify the patients according to disease activity or response to treatment.