{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T01:59:48Z","timestamp":1785117588338,"version":"3.55.0"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100001845","name":"Scleroderma Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001845","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"abstract":"\n Objective<\/jats:title>\n Elevated C\u2010reactive protein (CRP) levels in systemic sclerosis (SSc) have been linked with severe disease and worse survival, but the role of platelet levels remains unclear. This study examined whether elevated platelet levels, CRP levels, or both are associated with disease severity, progression, and survival in SSc.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We performed a retrospective study of adult patients with SSc seen from 1996 to 2022. Using the first blood draw after symptom onset, patients were categorized into four groups using cutoffs of \u2265330,000\/\u03bcL for platelets and \u22656.0 mg\/L for CRP: (1) normal platelet\/normal CRP (NP\/NC), (2) normal platelet\/elevated CRP (NP\/EC), (3) elevated platelet\/normal CRP (EP\/NC), (4) elevated platelet\/elevated CRP (EP\/EC).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n One hundred and thirty\u2010nine patients were included (84 NP\/NC [60%], 33 NP\/EC [24%], 10 EP\/NC [7%], and 12 EP\/EC [9%]). The EP\/EC had the highest rates of Scl\u201070 antibody positivity, diffuse skin involvement, myocarditis\/cardiomyopathy, dysphagia, gastric antral vascular ectasia, joint contractures, and digital ulcers (\n P<\/jats:italic>\n \u2009<\u20090.05). NP\/NC had the best baseline forced vital capacity, which remained stable over two years, though differences among groups over time were not significant. EP\/EC had the highest modified Rodnan skin scores throughout the two\u2010year period (\n P<\/jats:italic>\n \u2009<\u20090.05). Median survival was lowest in the EP\/EC group (9.6 years vs 21.3 years in NP\/NC,\n P<\/jats:italic>\n \u2009<\u20090.0001), with an adjusted hazard ratio of 7.34 (95% CI 2.40\u201322.41, Bonferroni\u2010adjusted\n P<\/jats:italic>\n \u00a0=\u00a00.0025). Patients with isolated CRP or platelet elevation demonstrated intermediate disease severity compared with the dual\u2010elevation group.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Elevated platelet levels in combination with elevated CRP levels identifies patients with SSc with severe disease and poor survival, who may warrant aggressive screening and treatment of complications.<\/jats:p>\n \n \n \n image<\/jats:alt-text>\n <\/jats:graphic>\n <\/jats:boxed-text>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/acr.80116","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T21:19:37Z","timestamp":1784755177000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Elevated Platelets and C\u2010Reactive Protein With Severe Disease and Poor Survival in Systemic Sclerosis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0878-245X","authenticated-orcid":false,"given":"Brian S.","family":"Lee","sequence":"first","affiliation":[{"name":"Stanford University Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shufeng","family":"Li","sequence":"additional","affiliation":[{"name":"Stanford University Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srijana","family":"Davuluri","sequence":"additional","affiliation":[{"name":"Stanford University Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Lee","sequence":"additional","affiliation":[{"name":"Palo Alto VA Health Care System Palo Alto California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorinda","family":"Chung","sequence":"additional","affiliation":[{"name":"Stanford University Stanford California"},{"name":"Palo Alto VA Health Care System Palo Alto California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,26]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"StatPearls","author":"Adigun R","year":"2025"},{"key":"e_1_2_6_3_1","volume-title":"StatPearls","author":"Odonwodo A","year":"2025"},{"key":"e_1_2_6_4_1","first-page":"99","volume-title":"Interdisciplinary Rheumatology: Rheumatology and Nephrology","author":"Lee BS","year":"2024"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01692-0"},{"key":"e_1_2_6_6_1","volume-title":"Harrison's Principles of Internal Medicine","author":"Varga 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