D-dimer as a bio-marker for assessment of disease activity in Rheumatoid Arthritis patients

Background Rheumatoid arthritis (RA) is considered the most common inflammatory joint disorder. It can lead to early morbidity, mortality and increased incidence of functional disability. Achieving rapid remission in early disease appears to be a beneficial strategy in preventing work disability in RA patients. The lack of specificity of commonly used inflammatory markers prompted the investigation of novel ones for estimating disease activity in RA. D-dimer has been one of these new markers, as RA is known to induce a hypercoagulable state. Aim This study aimed to investigate the possibility of utilizing D-dimer as a potential marker for assessing RA disease activity, alongside other more widely used inflammatory markers, including C-reactive protein (CRP) as well as erythrocyte sedimentation rate (ESR). Methods Serum D-dimer level was measured in 44 RA patients, classified into two main groups, low disease activity and remission group, and moderate and high disease activity group. In addition, a control group of 22 apparently healthy participants was enrolled. All patients with comorbidities, history of thromboembolic events, or on anti-coagulation therapy were excluded. Results Our study groups included female RA patients with mean age 43.48 ± 11.07. On comparing study groups, we demonstrated that serum D-dimer level was markedly elevated in RA patients in comparison with control group (1.55mg/L vs 0.35mg/L respectively, P value: 0.002). Serum D-dimer was higher in RA patients having high disease activity in comparison with RA patients with low disease activity (2.39mg/L vs 0.70mg/L respectively, P value < .00001). Furthermore, D-dimer correlated significantly with CRP, ESR, and disease activity score-28 measured both with CRP (DAS28-CRP) and ESR (DAS28-ESR). Conclusion D-dimer could provide a potentially useful tool in assessing RA activity when excluding other factors that might lead to its elevation.