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Correlation of Tumor Necrosis Factor-Alpha, High Sensitivity C-Reactive Protein, and Disease Activity Score 28 (DAS28) in Rheumatoid Arthritis Patients

Inflammatory markers such as tumor necrosis factor-alpha (TNF-α) and high sensitivity C-reactive proteins (hs-CRP) have been suggested as markers disease activity (severity) in patients with rheumatoid arthritis (RA) but the data are limited. The aim of this study was to determine the correlation between both TNF-α and hs-CRP levels and disease activity of RA patients. A cross sectional study was conducted at Dr. Soetomo Hospital, Surabaya, Indonesia. Plasma levels of TNF-α and hs-CRP were determined by ELISA and solid-phase chemiluminescent immunometric assay, respectively and the degree of disease activity (severity) was measured using disease activity score 28 (DAS28). The levels of TNF-α and hs-CRP between the level of disease severity were compared using Anova test and the correlations of TNF-α or hs-CRP level and DAS28 were tested using Pearson’s or Spearman correlation as appropriate. Thirty-one patients were enrolled in this study, where most of them (87.1%) were women, with mean of age 45.61 years. Based on DAS28 score, 45.2% of the patients were categorized as high disease activity (severe). The level of TNF-α was statistically significant between disease activity groups (high vs. moderate with p=0.012; and high vs. low with p=0.036). There was a significant positive correlation between the TNF-α and DAS28 score (r=0.417, p=0.02). No correlation between hs-CRP and DAS28 score (r= -0.117, p=0.532). The level of TNF-α is associated with DAS28 score, suggesting its potential as a marker of RA disease activity or severity. Further studies are therefore warrant to validate this finding in order to provide more robust evidence.