cqvip:Objective.Clinical interest in C-reactive protein(CRP)-a component of the innate immune system-has focused mainly on its worth as an indicator of disease activity.There has been a resurgence of interest in CRP in the Crohn’s disease(CD)literature because several trials of new treatments for active CD have been characterized by both a large proportion of patients with low CRP( 200.The low CRP group was compared with patients in the raised CRP group for a range of clinical variables as well as the major NOD2 variants.Results.There were data sets for 223 CD patients,with a mean disease duration of 12 years.Of these,22 patients fulfilled the criteria for low CRP.The low CRP group(group 1)showed significant differences for disease site(p < 0.01)and for BMI(p = 0.006)compared to the raised CRP group(group 2).Specifically,group 1 had a predominance of pure ileal disease(95%versus 53%)and lack of pure colonic disease(0%versus 24%)compared to group 2,and their BMI was significantly lower(20.3 kg/m2 versus 25.0 kg/m2).Groups 1 and 2 did not differ with respect to Vienna behaviour at diagnosis,smoking,appendicectomy,extra-intestinal manifestations of CD,or NOD2 SNP variants.There was a trend for low CRP patients with previous ileal resection to evolve to a stricturing phenotype.Fat wrapping was noted in 11/13(85%)of low CRP patients undergoing ileal resections.Conclusions.Patients with CD and a persistently low CRP in the face of active disease were characterized by an almost exclusive ileal disease distribution and a low BMI,compared to those with a raised CRP.These patients had a similar frequency and distribution of NOD2/CARD15 variants.Stricturing(inflammatory or penetrating)behaviour may explain some low CRP.Despite the abnormally low BMI,fat wrapping was noted in the majority of low CRP patients undergoing ileal resection.
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