Background Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint pain and swelling, as well as destruction of synovial joints leading to significant morbidity and mortality1. Patients are classified as having RA with a combination of a history of prolonged symptom duration, a swelling of joints on physical examination, serological markers including rheumatoid factor (RF), anti-cyclic citrullinated peptide (CCP) antibodies, and acute-phase response measures including the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)2. The blood neutrophil-to-lymphocyte ratio (NLR) has been identified as a potentially useful marker of disease activity in disease states with an inflammatory component such as malignancies, cardiovascular disease, and rheumatologic diseases3–5.
Objectives To investigate whether NLR can be used as a marker of inflammation and disease activity in RA patients with varying disease activity levels as assessed by the RAPID 3 (routine assessment of patient index data 3) at their most recent visit in the rheumatology clinic.
Methods We conducted a retrospective chart review of 229 consecutive patients with a diagnosis of RA as determined using the 2010 ACR criteria for diagnosis of RA seen at the outpatient Rheumatology clinic of Einstein Medical Center in Philadelphia, PA, a tertiary urban hospital. At the time of each visit, each patient completes the RAPID3 questionnaire and the data are recorded in the electronic medical record. NLR was calculated using data from the complete blood count drawn at the time of the visit. Pearson's correlation coefficient (r) between NLR and well accepted disease activity markers (RAPID 3, ESR, CRP) was calculated. Multivariate linear regression was also performed to assess the association of the above variables.
Results Two hundred seven patients (85% women) with a mean age of 59.6 years were included in the analysis. At the time of the random visit, mean NLR was 2.97, RAPID 3 score 13.8, ESR 36.5 mm/hr and CRP 2.3 mg/L. The NLR significantly correlated with RAPID 3 score (r=0.24, p<0.01), but not ESR (r=0.1, p=0.13) or CRP (r=0.12, p=0.07). Multivariate linear regression analysis showed that NLR was independently associated with RAPID 3 score (b=0.75, p<0.01).
Conclusions NLR is an inexpensive and readily available inflammatory marker which may be useful as an indicator of disease activity in patients with RA.
Wolfe F. The natural history of rheumatoid arthritis. J Rheumatol Suppl 1996;44:13–22
D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Ann Rheum Dis 2010; 69:1580–1588
Kim JY et al. 2013 Prognostic importance of baseline neutrophil to lymphocyte ratio in patients with advanced papillary thyroid carcinomas. Endocrine. doi:10.1007/s12020-013-0089-6
T amhane UU et al. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008; 102:653–657
Makay B et al. The relationship of neutrophil-to-lymphocyte ratio with gastrointestinal bleeding in Henoch–Schonlein purpura. Rheumatol Int 2014 DOI 10.1007/s00296–014–2986–2
Disclosure of Interest None declared
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