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. 2004 Jul;63(7):831–835. doi: 10.1136/ard.2002.004796

Serum amyloid P component levels are not decreased in patients with systemic lupus erythematosus and do not rise during an acute phase reaction

M Bijl 1, H Bootsma 1, Y van der Geld 1, P Limburg 1, C Kallenberg 1, M H van Rijswijk 1
PMCID: PMC1755047  PMID: 15194579

Abstract

Background: Serum amyloid P component (SAP) and acute phase proteins like C-reactive protein contribute to the clearance of apoptotic cells. This response is diminished in systemic lupus erythematosus (SLE).

Objectives: To analyse SAP concentrations in SLE in relation to disease activity, and investigate whether SAP reacts like an acute phase protein.

Methods: SAP was measured in 40 patients with SLE during active and inactive disease and compared with healthy controls and patients with rheumatoid arthritis and Wegener's granulomatosis. Normal SAP values were determined in 120 healthy controls by ELISA. C reactive protein and serum amyloid A (SAA) were measured in all subjects and their levels related to SAP. SAP was also measured serially in 11 patients with breast cancer treated with recombinant human interleukin-6, and in 16 patients with sepsis.

Results: In SLE, SAP was unaltered compared with healthy controls and was not influenced by disease activity, in contrast to C reactive protein and SAA, which increased during active disease. SAP increased in Wegener's granulomatosis but not in rheumatoid arthritis. The rise in C reactive protein and SAA was most pronounced in Wegener's granulomatosis with active disease. SAP did not change significantly during an acute phase response. No correlation was found between SAP and C reactive protein or SAA, but there was a correlation between SAA and C reactive protein (r = 0.4989, p = 0.0492).

Conclusions: Patients with SLE have normal circulating SAP levels. In contrast to C reactive protein or SAA, SAP does not act as an acute phase protein.

Full Text

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Figure 1.

Figure 1

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 Serum amyloid P component (SAP) in male (n = 39) and female (n = 81) healthy controls (empty circles) and in male (n = 4) and female (n = 36) SLE patients during inactive disease (filled circles). Horizontal bars indicate the mean.

Figure 2.

Figure 2

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 Serum amyloid P component (SAP) (A), C reactive protein (B), and serum amyloid A (SAA) (C) values in 40 patients with SLE during active disease. Disease manifestations were divided into organ manifestations based on the ACR criteria of SLE: RE, renal; CE, cerebral; SK, skin; HA, haematological; MU, musculoskeletal; SE, serositis. More than one organ system could be involved in an individual patient. Horizontal bars indicate the mean.

Figure 3.

Figure 3

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 Serum amyloid P component (SAP) in healthy controls (n = 120), SLE (n = 40), rheumatoid arthritis (n = 31), and Wegener's granulomatosis (n = 25). SAP in the patients was measured during inactive disease. Horizontal bars indicate the mean. ***p<0.001 by one way analysis of variance with Bonferroni's multiple comparison test.

Figure 4.

Figure 4

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 Serum amyloid P component (SAP) does not behave as an acute phase protein. (A) SAP, C reactive protein, and serum amyloid A (SAA) responses in a patient with breast cancer treated for seven days with recombinant interleukin 6 (rhIL-6) at a dose of 20 µg/kg/day. Even though a significant increase in C reactive protein (from18 to 395 mg/l on day 3) and an even more pronounced increase in SAA (from 11 to 770 mg/l on day 3) occurred, SAP levels hardly changed. (B) SAP levels of the same patient in more detail, showing a decline in SAP up to day 3, at the maximum of the acute phase response, and a slight increase thereafter.

Selected References

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