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Question - Calprotectin Results

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Ulcerative Colitis
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Posted 6/20/2017 6:37 PM (GMT 0)
Hey, all!

So I've been doing (knock on wood) much better since my 3rd Remicade infusion five weeks ago. I'm eating pretty normally and for the most part, my GI symptoms are cleared up, though I am still having joint and muscle pain/stiffness that started a few weeks ago.

I'm starting to get some labs back from my most recent visit with the GI, where we discussed the joint pain. We ran a test for drug-induced Lupus (negative), Vitamins D and B12 (normal), Remicade anitbodies (still pending), C Diff (negative) and stool calprotectin.

The calprotectin was >2,000 in March when I was probably at my worst. It was 84.7 ten days ago. Normal is 50 or less.

So - any thoughts on that calprotectin result? Should I be concerned that it's not normal after 3 doses of Remicade, or just keep an eye on it? He is calling that number "slightly elevated." Anyone have experience with this test who can help me understand whether that result is concerning?

Thanks, all!
Posted 6/20/2017 7:58 PM (GMT 0)
Actually, I think I've answered my own question - and found some information that may help others.

First - on the test itself, it says this in small print:

"Interpretation: Borderline (50.1-120.0 mcg/g)" - so that's why the GI is saying "slightly" elevated.

Second, I found this very interesting - and current - article with a great Q&A about calprotectin. Of particular interest:

"Can fecal calprotectin predict clinical relapse of IBD?

Calprotectin predicts imminent clinical relapse with an 80% sensitivity and accuracy in patients with established, relatively asymptomatic IBD (ulcerative colitis or Crohn’s disease). A patient with asymptomatic IBD with a high calprotectin level has an 80% chance of a clinical relapse in the next 6 months, whereas only 20% of patients with a low calprotectin level will experience a clinical relapse. The precise cutoff value for the distinction between high and low calprotectin levels in this context is variable. Data from my colleagues and I suggest a cutoff point of 250 µg/mg, but other investigators have suggested somewhat lower cutoff points using receiver operating characteristic curve analyses. One study using leukocyte aphaeresis showed that treatment at this asymptomatic stage could avert clinical relapse. It is also possible that simpler treatment, such as dose escalation of 5-aminosalicylates or a short sharp course of corticosteroids, would have the same effect, but this has yet to be studied."

http://www.gastroenterologyandhepatology.net/archives/january-2017/the-use-of-fecal-calprotectin-in-inflammatory-bowel-disease/
Posted 6/20/2017 8:04 PM (GMT 0)
I'm glad you're feeling better and have made good progress. It took a full year for me to reach a remission on Remicade, so it isn't unexpected that you'd still have a slightly-elevated FCP score after completing only the loading doses. So, I'd recommend giving it a few more infusions and I bet if you were to re-check then you should get a lower FCP score and also continue healing and feel even better. I saw a slow but steady improvement on remicade once I was on the 8 week maintenance cycle. The biggest and fastest improvements were while on the loading doses.

The pains are concerning, see what the remicade-antibody results say. If you have high-antibodies then it could explain the pains you're having. If there are not any antibodies than it could be something else entirely.
Posted 6/21/2017 4:52 PM (GMT 0)
Just out of interest what type of joint pain do you have? Are they in areas that are unusual for you to have pain? My GI in Canada who is really well respected thinks the key numbers are your CRP numbers and trough levels. But, he always reminds me that symptoms trump all. I was concerned my CRP went from 0 to 4 but he says it most likely normal inflammation in the body now that i am not suffering GI symptoms and back to by regular physical activity and not docile as i was when i was ill.
Posted 6/21/2017 7:10 PM (GMT 0)
Thanks, Hugo18! This pain is very unusual for me. It started about three weeks after my last infusion, and is in my hips, lower back, occasionally elbows and shoulders, once in a while in my right knee. It seems to move around a bit and is a combination of joint pain, stiffness and muscle stiffness as well. Sitting still makes it worse, but it's no worse in the morning than late in the day.

We're waiting for the remicade antibodies test - really hoping that I'm not forming antibodies. CRP was normal at last infusion.
Posted 6/21/2017 8:07 PM (GMT 0)
Pain moves around, huh? Sounds like this:

Peripheral Arthritis. Peripheral arthritis usually affects the large joints of the arms and legs, including the elbows, wrists, knees, and ankles. The discomfort may be “migratory,” moving from one joint to another. If left untreated, the pain may last from a few days to several weeks. Peripheral arthritis tends to be more common among people who have ulcerative colitis or Crohn’s disease of the colon. The level of inflammation in the joints generally mirrors the extent of inflammation in the colon. Although no specific test can make an absolute diagnosis, various diagnostic methods—including analysis of joint fluid, blood tests, and X-rays—are used to rule out other causes of joint pain. Fortunately, IBD-related peripheral arthritis usually does not cause any lasting damage and treatment of the underlying IBD typically results in improvement in the joint discomfort.

www.crohnscolitisfoundation.org/assets/pdfs/arthritiscomplications.pdf
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