Fluctuations in Hs-CRP Levels for Ankylosing Spondylitis Patients

Does eating salad cause fluctuations in hs-CRP levels?

Hello Doctor, I am a patient with ankylosing spondylitis, and my main symptom is pain in the buttocks.
Since March 2nd of last year, I have been taking two Salazopyrin daily and only taking Voltaren when I experience pain (the pain has improved significantly).
Before March 2nd, I was only taking Celebrex (without Salazopyrin).
I would like to focus on the period after March 2nd.
Since then, I have had five blood tests: March 2, 2022 (Hscrp 0.57, ESR 20), May 25, 2022 (Hscrp 0.20, ESR 39), September 19, 2022 (Hscrp 0.38, ESR 56), November 16, 2022 (Hscrp 0.91, ESR 22), and February 22, 2023 (Hscrp 1.05, ESR 32).
From March 2nd to November 16th, the Hscrp levels were well controlled, but after November 16th, the Hscrp index rose to around 1 (and it has been around 1 for two consecutive tests).
I would like to ask the doctor: 1) For general ankylosing spondylitis patients, is it possible for Salazopyrin to suddenly become ineffective in controlling Hscrp levels without any specific circumstances, especially when the medication has not been interrupted? (The change seems quite significant from around 0.2, 0.4 to around 0.9, 1.) 2) I forgot to take Salazopyrin for two weeks prior to the tests on November 16, 2022, and February 22, 2023.
Could the lack of Salazopyrin during those two weeks have caused the Hscrp levels to rise to 1? 3) I was diagnosed with COVID-19 on October 3, 2022, but it was a mild case, and I recovered in two weeks.
Could this diagnosis have caused the Hscrp levels to rise to 1 after November 16th? 4) I have noticed that my buttock pain tends to occur more frequently during cold weather.
Could the winter season have contributed to the rise in Hscrp levels to 1 after November 16th? (However, it wasn't very cold before November 16th.) I apologize for the many questions, and thank you, Doctor.

Hao, 20~29 year old female. Ask Date: 2023/03/02

Dr. Zeng Guosen reply Internal Medicine

1) The activity of ankylosing spondylitis naturally fluctuates and is not ineffective.
2) It is possible that medication was not taken, or the disease itself may be changing.
3) There are reports indicating that COVID-19 infection can lead to increased instability in autoimmune diseases.
4) Cold weather can make rheumatic pain more sensitive and intensify the pain, but it does not activate the disease.
Thank you for your question.

Reply Date: 2023/03/02

More Info

Understanding fluctuations in high-sensitivity C-reactive protein (hs-CRP) levels is crucial for managing conditions like ankylosing spondylitis (AS). As a patient with AS, you are likely aware that this condition can lead to chronic inflammation, particularly affecting the spine and sacroiliac joints. The hs-CRP test is a sensitive marker for inflammation and can help monitor disease activity and treatment efficacy.

1. Fluctuations in hs-CRP Levels: It is not uncommon for hs-CRP levels to fluctuate in patients with AS, even when they are on a consistent treatment regimen like Salazopyrin (sulfasalazine). Various factors can contribute to these fluctuations, including stress, infections, and changes in physical activity. In your case, the increase from 0.2 to around 1.0 mg/L could indicate a temporary exacerbation of inflammation, possibly due to an underlying infection or other stressors on your body.
2. Impact of Medication Adherence: You mentioned that you forgot to take Salazopyrin for two weeks before your tests on November 16 and February 22. Missing doses of anti-inflammatory medications can indeed lead to a rise in inflammatory markers like hs-CRP. Salazopyrin is known to help control inflammation in AS, and inconsistent use may result in a resurgence of symptoms and elevated hs-CRP levels. It’s essential to maintain a regular medication schedule to manage your condition effectively.

3. Post-COVID-19 Effects: Having contracted COVID-19, even with mild symptoms, could also contribute to changes in your hs-CRP levels. Viral infections can provoke an inflammatory response, and it’s possible that the aftermath of the infection could lead to elevated hs-CRP levels. The body may take time to return to its baseline inflammatory state after an infection, and this could explain the increase in hs-CRP levels following your COVID-19 diagnosis.

4. Seasonal Changes and Pain Flare-Ups: You noted that your pain tends to worsen during cold weather. Weather changes can affect joint pain and inflammation in some individuals with AS. Cold temperatures may lead to increased muscle tension and stiffness, which can exacerbate pain and potentially influence inflammatory markers. However, the relationship between weather and hs-CRP levels can be complex and may vary from person to person.

In summary, fluctuations in hs-CRP levels in ankylosing spondylitis patients can be influenced by medication adherence, infections, and environmental factors. It’s essential to communicate these fluctuations with your healthcare provider, who can help interpret these changes in the context of your overall health and treatment plan. Regular monitoring of hs-CRP and other inflammatory markers, along with consistent medication use and lifestyle adjustments, can help manage your condition more effectively. If you notice persistent increases in hs-CRP or worsening symptoms, it may warrant further investigation or adjustments in your treatment regimen.

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