Background Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are launched as recent markers of inflammation in chronic inflammation principally in cancer and cardiovascular diseases (1–2).

Objectives Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic inflammatory disorders marked by variable periods of remissions and relapses.Inflammation is most likely the underlying cause in disability, increased comorbidity therefore need to be closely monitored and kept under control (3).For this reason cost effective, accessible and reliable parameters are needed in daily practice. Our aim is to analyze the relation between inflammation and NLR and PLR which are easily calculated from whole blood count parameters.

Methods Medical records of 425 subjects were analyzed retrospectively.Mean age of the subjects was 44,64±14,07 years (17–89 years),52.9% was female (n=225) and 47.1% was male (n=200).105 of them had RA, 216 of them had AS and 104 were healthy controls.2010 ACR/EULAR classification criteria and modified New York criteria were used for the diagnosis of RA and AS.Erythrocyte sedimentation rate (ESR), C reactive protein (CRP) and whole blood count were recorded with simultaneous DAS28 scores of patients with RA and BASDAI scores of patients with AS.

Results Hemoglobin levels of RA patients were significantly (p<0.05) lower then the levels of control group (p=0.001).ESR, CRP, NLR and PLR were significantly higher then the control group respectively (p=0.001, p=0.001, p=0.001, p=0.040).In AS group hemoglobin, ESR, CRP and NLR values were significantly higher then the control group respectively (p=0.001, p=0.006, p=0.001, p=0.001). No difference was detected between AS and control groups in terms of PLR (p>0.05).When patients with high disease activity and patients in remission were compared for both RA and AS groups ESR (p=0.001, p=0.001) and CRP scores (p=0.005, p=0.003) were significantly lower respectively. No statistical significance was found in terms of NLR and PLR (p>0.05).Significant positive correlation was found in RA patients with high disease activity between ESR, CRP, NLR and PLR. In AS patients with high disease activity significant positive correlation was found between ESR, NLR and PLR. No correlation was found between disease activity indices, NLR and PLR.

Conclusions With the advantage of cost effectiveness and easy calculation NLR and PLR in RA patients, and NLR in AS patients might be used as indicators of inflammation together with ESR and CRP or instances when they are not applicable.Although NLR and PLR are useful in the discrimination of healthy and diseased subjects, they are not sufficient to determine disease activity because not only laboratory parameters but clinical findings and self assessment of the patient are also included in activity measurement.

References

1. Yang HB, Xing M, Ma LN, Feng LX, Yu Z.Prognostic significance of neutrophil-lymphocyte ratio/platelet-lymphocyte ratio in lung cancers:a meta-analysis. Oncotarget. 2016 Nov 22;7(47):76769–76778.

2. Wiwanitkit V. Neutrophil-to-Lymphocyte Ratio,Platelet-to-Lymphocyte Ratio and Heart Failure.Arq Bras Cardiol. 2016 Mar;106(3):265.

3. Mercan R, Bitik B, Tufan A, Bozbulut UB, Atas N, Ozturk MA, Haznedaroglu S, Goker B. The Association Between Neutrophil/Lymphocyte Ratio and Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis. J Clin Lab Anal. 2016 Sep;30(5):597–601.

References

Disclosure of Interest None declared