Analysis of peripheral blood parameters for the diagnosis of inflammatory activity in rheumatoid arthritis

Currently, it is considered generally accepted to assess the activity of inflammation in rheumatoid arthritis (RA) according to the disease activity index (DAS28), which requires computer technology. However, there have been reports that inflammatory activity in autoimmune diseases can be diagnosed with peripheral blood counts.
Aim. To clarify the possibility of using peripheral blood parameters for the diagnosis of inflammatory activity in rheumatoid arthritis.
Material and methods. The study included 100 patients with RA who were consecutively hospitalized in the first quarter of 2021 due to an exacerbation. The control group consisted of 59 healthy donors. When patients were admitted to the clinic, along with standard clinical, laboratory and radiological parameters, the neutrophil-tolymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios were determined.
Results. Correlation analysis of the studied clinical and laboratory parameters of the inflammatory activity of RA patients using the Pearson method showed that the NLR indicator, in contrast to the PLR, was statistically significant (p<0.05) correlated with the swollen joint count (r=0.236), the values of C-reactive protein (CRP) (r=0.448), erythrocyte sedimentation rate (ESR) (r=0.274) and DAS28-ESR (r=0.274). ROC-analysis of the sensitivity and specificity of the NLR value in relation to the CRP and ESR indicators confirmed an acceptable level of sensitivity and specificity in assessing the inflammatory activity of RA.
Conclusions. The NLR index, calculated from the data of the analysis of peripheral blood, can be used in clinical practice as an objective and accessible marker of the inflammatory activity of RA.

1. Burmester GR, Pope JE. Novel treatment strategies in rheumatoid arthritis. Lancet. 2017;389(10086):2338-2348. doi: 10.1016/S0140-6736(17)31491-5

2. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569-2581. doi: 10.1002/art.27584

3. Smolen JS, Breedveld FC, Burmester GR, Bykerk V, Dougados M, Emery P, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis. 2016;75(1):3-15. doi: 10.1136/annrheumdis-2015-207524

4. Stoffer MA, Schoels MM, Smolen JS, Aletaha D, Breedveld FC, Burmester G, et al. Evidence for treating rheumatoid arthritis to target: Results of a systematic literature search update. Ann Rheum Dis. 2016;75(1):16-22. doi: 10.1136/annrheumdis-2015-207526

5. Karateev DE, Olyunin YuA. On the classification of rheumatoid arthritis. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2008,46(1):5-16 (In Russ.). doi: 10.14412/1995-4484-2008-1

6. Nasonov EL (ed.). Rheumatology. Russian clinical recommendations. Moscow:GEOTAR-Media;2017 (In Russ.).

7. Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD. The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Ann Lab Med. 2019;39(4):345-357. doi: 10.3343/alm.2019.39.4.345

8. Yang Z, Zhang Z, Lin F, Ren Y, Liu D, Zhong R, et al. Comparisons of neutrophil-, monocyte-, eosinophil-, and basophil- lymphocyte ratios among various systemic autoimmune rheumatic diseases. APMIS. 2017;125(10):863-871. doi: 10.1111/apm.12722

9. Hao X, Li D, Wu D, Zhang N. The relationship between hematological indices and autoimmune rheumatic diseases (ARDs), a meta-analysis. Sci Rep. 2017;7(1):10833. doi: 10.1038/s41598-017-11398-4

10. Erre GL, Paliogiannis P, Castagna F, Mangoni AA, Carru C, Passiu G, et al. Meta-analysis of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in rheumatoid arthritis. Eur J Clin Invest. 2019;49(1):e13037. doi: 10.1111/eci.13037

11. Uslu AU, Küçük A, Şahin A, Ugan Y, Yılmaz R, Güngör T, et al. Two new inflammatory markers associated with Disease Activity Score-28 in patients with rheumatoid arthritis: Neutrophillymphocyte ratio and platelet-lymphocyte ratio. Int J Rheum Dis. 2015;18(7):731-735. doi: 10.1111/1756-185X.12582

12. Rosas EC, Correa LB, das Graç as Henriques M. Neutrophils in rheumatoid arthritis: A target for discovering new therapies based on natural products. In: Khajah MA. Role of neutrophils in disease pathogenesis. London:IntechOpen;2017. URL: https://www.intechopen.com/books/role-of-neutrophils-in-disease-pathogenesis/neutrophils -in-rheumatoid-arthritis-a-target-for-discovering-newtherapies-based-on-natural-products (Accessed: 17th February 2018).

13. Cross A, Bucknall RC, Cassatella MA, Edwards SW, Moots RJ. Synovial fluid neutrophils transcribe and express class II major histocompatibility complex molecules in rheumatoid arthritis. Arthritis Rheum. 2003;48(10):2796-2806. doi: 10.1002/art.11253

14. Khandpur R, Carmona-Rivera C, Vivekanandan-Giri A, Gizinski A, Yalavarthi S, Knight JS, et al. NETs are a source of citrullinated autoantigens and stimulate inflammatory responses in rheumatoid arthritis. Sci Transl Med. 2013;5(178):178ra40. doi: 10.1126/scitranslmed.3005580

15. Corsiero E, Pratesi F, Prediletto E, Bombardieri M, Migliorini P. NETosis as source of autoantigens in rheumatoid arthritis. Front Immunol. 2016;7:485. doi: 10.3389/fimmu.2016.00485

16. Andia I. Rheumatoid arthritis: The ins and outs of platelets in RA. Nat Rev Rheumatol. 2017;13(5):262-264. doi: 10.1038/nrrheum.2017.52