Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratios Correlation with Rheumatoid Arthritis Disease Activity

Abstract BACKGROUND: Rheumatoid arthritis (RA) disease is a well-known systemic autoimmune illness typified by symmetrical polyarticular arthritis. Monitoring disease activity is essential to manage RA effectively. In recent years, there was a growing use of various inflammatory biomarkers to assess disease activity. Examples of newly developed markers that have drawn interest are neutrophil/lymphocyte ratio (NLR) and platelets/lymphocyte ratio (PLR) which may offer an affordable and cost-effective method in determining disease activity and directing therapy choices. OBJECTIVE: To explore possible correlation between NLR, PLR, and disease activity in RA patients. PATIENTS AND METHODS: This is a cross-sectional study involving 261 RA patients older than 16 years. All patients were interviewed, and physically examined, and their disease activity was assessed using Disease Activity Score-28 (DAS28) and Clinical Disease Activity Index (CDAI) scores. Blood samples were taken and tested for erythrocyte sedimentation rate (ESR) and complete blood count (CBC). NLR and PLR were calculated as a simple ratio between the neutrophil, lymphocyte, and platelet counts derived from CBC. Patients were divided according to DAS28 values into four categories: remission, mild, moderate, and severe. RESULTS: Significant positive correlations were showed between NLR and ESR ( P < 0.001), DAS28 ( P < 0.001), and CDAI ( P = 0.0031). Patients with severe DAS28 scores showed higher NLR, and PLR compared to those with nonsevere (mild and moderate) scores with a statistically significant difference ( P = 0.018) for NLR, ( P = 0.014) for PLR. No significant correlation between PLR and both DAS28 and CDAI was found. CONCLUSION: A significant correlation was found between NLR and traditional markers of RA activity as ESR, DAS28, and CDAI. Patients with severe disease activity showed the highest levels of NLR and PLR compared with those of nonsevere disease.