C-Reactive Protein and Erythrocyte Sedimentation Rate in Patients With Heterotopic Ossification After Spinal Cord Injury

• Published in: The journal of spinal cord medicine Vol. 27; no. 5; pp. 434 - 437
• Main Authors: Estrores, Irene M., Harrington, Amanda, Banovac, Kresimir
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01-01-2004
• Subjects: Adult; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Blood Sedimentation - drug effects; C- Reactive Protein; C-Reactive Protein - metabolism; Erythrocyte Sedimentation; Etidronate; Etidronic Acid - therapeutic use; Female; Heterotopic Ossification; Humans; Inflammation - blood; Inflammation - diagnosis; Male; Middle Aged; Nonstero Idal Anti-Inflammatory Drugs; Ossification, Heterotopic - blood; Ossification, Heterotopic - diagnosis; Ossification, Heterotopic - drug therapy; Paraplegia; Paraplegia - blood; Quadriplegia - blood; Rate; Retrospective Studies; Spinal Cord Injuries; Spinal Cord Injuries - blood; Spinal Cord Injuries - complications; Spinal Cord Injuries - drug therapy; Tetraplegia; Treatment Outcome
• ISSN: 1079-0268; 2045-7723
• DOI: 10.1080/10790268.2004.11752233

Background/Objective: Formation of heterotopic ossification (HO) in soft tissue afterspinal cord injury (SCI) is associated with various degrees of inflammation. Recent studies have shown that inhibition of inflammatory reaction with nonsteroidal anti-inflammatory drugs is an effective prevention of HO after SCI. The goal of this study was to monitor the activity of the most widely used indicators of acute inflammation-namely, erythrocyte Sedimentation rate (ESR) and C-reactive protein (CRP)-in patients with HO.
Methods: In a retrospective study, the results of 37 patie nts with HO were evaluated. There were 25 patients with tetraplegia and 12 with paraplegia. The age (mean ± SD) of the patients was 2 8 ± 8 years (range = 19-46 years). The patients were admitted to the rehabilitation center 2 to 5 weeks after SCI. HO was confirmed by bone scintigraphy. Blood samples were obtained from the patients at the time of diagnosis of HO and du ring the therapy. ESR was measured with the Westergren method, and serum CRP was determined by enzyme-linked immunosorbent assay.
Results: In the acute stage of HO, both tests were e levated in all patients. ln the later stages when clinical signs and symptoms of inflammat ion were resolving, both tests showed a gradual decline. When clinical sig ns and symptoms of inflammation (fever, acute soft tissue swelling, and erythema) were not present, the concentration of CRP was normal in 91 .2% of patients, whereas only 1 7 .6% of patients had normal ESR. Mean serum concentrations of CRP were 8.9 ±5.6 mg/L in the inflammatory phase and 0.9 ± 0.6 mg/L in the noninflammatory phase.
Conclusion: The data indicate that serum CRP is a useful and more specific test than is ESR for monitaring the inflammatory activity of HO after SCI. The normalization of CRP was seen during the first 3 to 4 weeks of etidronate therapy, indicating a resolution of acute-phase inflammatory reaction.