Neutrophil: Lymphocyte Ratio and Platelet: Lymphocyte Ratio related to Disease Activity among Rheumatoid Arthritis in Erbil governorate/Iraq

Authors

Zekra Ali Aziz, Department of Prosthetic and Orthotics,Erbil TechnicalHealth and Medical CollegeFollow
Dashty A. Al-Bustany, Department of MedicineFollow

Corresponding Author

Zekra A. Aziz

Authors ORCID

0000-0002-8644-2939

Document Type

Research Article

Abstract

Rheumatoid Arthritis (RA) is a systemic autoimmune inflammatory disorder that causes joints destruction the aim here is to investigate the neutrophil - to - lymphocyte ratio (NLR) and platelet - to- lymphocyte ratio (PLR) in RA patients and relation to Disease Activity Score of 28 joints (DAS28-ESR). The study population included (260) participants which consist of (210) RA patients and (50) healthy persons as a control. RA patients were two groups (107) received conventional diseases modified anti-rheumatic drugs (cDMARD) and (103) received biological agents (bDMARD) plus cDMARD each group subdivided into disease active patients (DAS28-ESR ≥ 2.6) and patients in remission (DAS28-ESR < 2.6). NLR in cDMARD, bDMARD plus cDMARD, and control group was 3.1 (±3.4), 2.2 (±1.3), and 2.4 (±1.3) respectively. PLR in cDMARD, bDMARD plus cDMARD, and control group was 193.3 (±355.3), 115.7 (±42.7), and 115.6 (±43.1) respectively. There was statistically significant difference in NLR and PLR among three groups (p = 0.023 and p = 0.030) respectively also according to DAS28-ESR in patients with active disease (p = 0.006) for both NLR and PLR, while for patients in remission NLR and PLR there were no significant differences detected (p = 0.901 and p = 0.638 respectively). The result of the current study support the idea that NLR and PLR can be considered as inflammatory parameters for evaluating disease activity in RA patients.

Keywords

Rheumatoid arthritis, Disease activity, Neutrophil, Platelet, Lymphocyte

How to Cite This Article

Aziz, Zekra Ali and Al-Bustany, Dashty A. (2022) "Neutrophil: Lymphocyte Ratio and Platelet: Lymphocyte Ratio related to Disease Activity among Rheumatoid Arthritis in Erbil governorate/Iraq," Polytechnic Journal: Vol. 12: Iss. 1, Article 10.
DOI: https://doi.org/10.25156/ptj.v12n1y2022.pp79-88

References

Abd-Elazeem MI and Mohamed RA, 2018. Neutrophil lymphocyte and platelet lymphocyte ratios in rheumatoid arthritis patients: relation to disease activity. Egypt Rheumatol.; 40:227‐231.

Armen Y G, Lilit A, Ulzhan M, Marlen Y, and George D. Kitas, 2019. The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases Ann Lab Med;39:345-357 .

Assayag D, Lee JS and King TE Jr, 2014. Rheumatoid arthritis associated interstitial lung disease: a review. Medicina (B Aires); 74 (2), 158–65.

Bruno F, Suzanne M.M, Vertappen and Annelies B, 2011. Economic consequences and potential benefits. Best Pract Res Clin Rheumatol, 27, pp. 607–624.

Balkarli A, Kucuk A, Babur H, and Erbasan F, 2016.Neutrophil/lymphocyte ratio and mean platelet volume in Behçet's disease. Eur Rev Med Pharmacol Sci.; 20:3045-3050.

Bruno F, Stephene M, and Peter T, 2018. Treatment of Rheumatoid arthritis. In: Johannes WJ. and Eric H. (Eds.), Eular Textbook on rheumatic diseases 3rd ed. BMJ Publishing Group;10:279.

Chandrashekara S, Rajendran A, Bai Jaganath A, and Krishnamurthy R., 2015. Neutrophil-lymphocyte ratio, pain perception, and disease activity score may serve as important predictive markers for sustained remission in rheumatoid arthritis. Reumatismo; 67(3):109–115.

Chandrashekara, S, Mukhtar Ahmad M, Renuka, P, Anupama, K.R, and Renuka, K, 2017.

Characterization of neutrophil-to-lymphocyte ratio as a measure of inflammation in rheumatoid arthritis. Int. J. Rheum. Dis.; 20, 1457–1467.

Choi JL, Li S and Han JY, 2014. Platelet function tests: a review of progresses in clinical application. Biomed Res Int; 456569.

Colglazier CL, and Sutej PG, 2005. Laboratory testing in the rheumatic diseases: a practical review. South Med J; 98(2):185–91.

Du J, Chen S, Shi J, Zhu X, Ying H, Zhang Y, Chen S, Shen B, and Li J, 2017. The association between the lymphocytemonocyte ratio and disease activity in rheumatoid arthritis. Clin Rheumatol.; 36:2689-2695.

Elena M., Carl T. and Eric L. Matteson, 2019. Extraarticular features of rheumatoid arthritis. In: Marc C. Hochberg, Ellen M. Gravallese, Alan J. Silman et. al.Rheumatology7thed. Elsevier, Philadelphia; 95:768.

Erre GL, Paliogiannis P, Castagna F, Mangoni AA, Carru C, Passiu G, and Zinellu A, 2018. Meta-analysis of neutrophilto-lymphocyte and platelet-to-lymphocyte ratio in rheumatoid arthritis. Eur J Clin Investig. ; https ://doi.org/10.1111/eci.13037.

Fu H, Qin B, Hu Z, Ma N, Yang M, Wei T, Tang Q, Huang Y, Huang F, Liang Y et al., 2015. Neutrophil and platelet to lymphocyte ratios are correlated with disease activity in rheumatoid arthritis. Clin Lab.; 61:269‐273.

Han-N L, Yun-K K, Geun-T K, Eunyoung A, Min W S, Dong H S, and Seung-G L, 2019. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio as predictors of 12-week treatment response and drug persistence of anti-tumor necrosis factor-α agent in patients with rheumatoid arthritis. Rheumatol Int. May;39 (5):859-868.

Hobbs KF and Cohen MD, 2012. Rheumatoid arthritis disease measurement: a new old idea. Rheumatology;51(suppl 6). vi21-7.

Inoue E, Yamanaka H, Hara M, Tomatsu T, and Kamatani N, 2007 .Comparison of Disease Activity Score (DAS) 28- erythrocyte sedimentation rate and DAS28- C-reactive protein threshold values. Ann Rheum Dis; 66, 407–9.

Jin Z, Cai G, Zhang P, Li X, Yao S , Zhuang L , Ren M, Wang Q, and Yu X, 2021. The value of the neutrophilto-lymphocyte ratio and platelet-to-lymphocyte ratio as complementary diagnostic tools in the diagnosis of rheumatoid arthritis. J Clin Lab Anal.;35:e23569.

Karimifar M, Salesi M. and Farajzadegan Z , 2012. The association of anti-CCP1 antibodies with disease activity score 28 (DAS-28) in rheumatoid arthritis. Adv Biomed Res;1(30),6.

Kiely PD, Deighton C, Dixey J, and Ostor AJ, 2012. British Society for Rheumatology Standards, Guidelines and Audit Working Group: Biologic agents for rheumatoid arthritisnegotiating the NICE technology appraisals. Rheumatology (Oxford); 51: 24―31.

Kisacik B, Tufan A, Kalyoncu U, Karadag O, Akdogan A, Ozturk MA, Kiraz S, Ertenli I, and Calguneri M, 2008. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine.; 75: 291–4.

Kouri VP, Olkkonen J, Ainola M, Li TF, Björkman L, Konttinen YT, and Mandelin J, 2014. Neutrophils produce interleukin-17B in rheumatoid synovial tissue. Rheumatology; 53(1):39–47.

Kugyelka R, Kohl Z, Olasz K, Mikecz K, Rauch TA, Glant TT, and Boldizsar F, 2016. Enigma of IL-17 and Th17 cells in rheumatoid arthritis and in autoimmune animal models of arthritis. Mediators Inflamm; 6145810.

Maden M, Pamuk G. and Pamuk O., 2017. Development of atherosclerotic cardiovascular mortality in gouty arthritis and rheumatoid arthritis patients: are they associated with mean platelet volume and neutrophil lymphocyte ratio?. Arch Rheumatol.;32:39-45.

Masahito K, Susumu G, Kenji T, Toshikazu K, Shinro T and Hiroshi N, 2016 Neutrophil/Lymphocyte Ratio in Patients with Rheumatoid Arthritis Treated with Biological Agents J Nippon Med Sch; 83 (3).

Mercan R, Bitik B, Tufan A, Bozbulut UB, Atas N, Ozturk MA, Haznedaroglu S, and Goker B, 2016. The association between neutrophil/ lymphocyte ratio and disease activity in rheumatoid arthritis and ankylosing spondylitis. J Clin Lab Anal.;30:597‐601.

Mohamad, A.A., Majid, F.A.A., Assaw, S., Abidin, F.Z., Fadhlina, A., Aluru, S.K., Zainol, S.N. and Ahmed, N.J., (2021). “Anti-inflammatory and oral toxicity assessment of r-38tm: a traditional herbal supplement for arthritis”, Jurnal Teknologi, 84(1), pp. 249-262.

Muddathir ARM and Haj FEJ., 2013. Platelet indices in sudanese patients with rheumatoid arthritis. Asian J Biomed Pharm Sci.; 3: 1–3.

Park EY, Lee SG, Park EK, Koo DW, Park JH, Kim GT, Tag HS, Kim HO, and Suh YS, 2018. Drug survival and the associated predictors in South Korean patients with rheumatoid arthritis receiving tacrolimus. Korean J Intern Med; 33(1):193–202.

Peng Y-F, Cao L, Zeng Y-H, Chen D, Zhang Q, and Zhu YS, 2015. Platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in patients with rheumatoid arthritis. Open Med (Wars).;10:249-253.

Quaiser S. and Khan R., 2020. Correlation of neutrophil– lymphocyte ratio with disease activity in rheumatoid arthritis. J Clin Sci;17:46-8.

Sanmart -R, Ruiz-Esquide V. and Hern_andez MV., 2013. Rheumatoid arthritis: a clinical overview of new diagnostic and treatment approaches. Curr Top Med Chem; 13, 698– 704.

Scapini P. and Cassatella MA ., 2014. Social networking of human neutrophils within the immune system. Blood; 124, 710–9. Senem Şaş. and Kervansaray, 2019.

Neutrophil/lymphocyte and platelet/lymphocyte ratios are associated with disease activity in rheumatoid arthritis.J Clin Anal Med;10(3):379- 83.

Smolen JS, Breedveld FC, Burmester GR, Bykerk V, Dougados M, Emery P, Kvien TK, Navarro-Compan MV, Oliver S, Schoels M et al., 2016. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis; 75(1):3–15.

Tekeog˘lu I, Gürol G, Harman H, Karakeçe E, and Çiftçi IH, 2016. Overlooked hematological markers of disease activity in rheumatoid arthritis. Int J Rheum Dis; 19 (11):1078–82.

Uslu, A.U.; Küçük, A.; ¸Sahin, A., Ugan, Y.; Yılmaz, R.; Güngör, T.; Ba˘ gcacı, S.; Küçük¸ and sen, S, 2015. 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.; 18, 731–735.

Willemze A, Toes RE, Huizinga TW, and Trouw LA, 2012. New biomarkers in rheumatoid arthritis. Neth J Med; 70, 392–9.

Xuanyu H, Dongyang L, Dan W, and Ning Z, 2017. The Relationship between Hematological Indices and Autoimmune Rheumatic Diseases (ARDs), Published:07 September Scientific Reports; 7: 10833.

Yang Z, Zhang Z, Lin F, Ren Y, Liu D, Zhong R, and Liang Y, 2017. Comparisons of neutrophil, monocyte, eosinophil, and basophil lymphocyte ratios among various systemic autoimmune rheumatic diseases. APMIS.; 125:863‐871.

Yao Y, Simard AR, Shi FD, and Hao J, 2013. IL-10-producing lymphocytes in inflammatory disease. Int Rev Immunol; 32, 324–36.

Yazici S, Yazici M, Erer B, Calik Y, Ozhan H, and Ataoglu S, 2010. The platelet indices in patients with rheumatoid arthritis: mean platelet volüme reflects disease activity. Platelets; 21: 122–5.

Yolbas S, Yildirim A, Gozel N, Uz B, and Koca SS., 2016.

Hematological indices may be useful in the diagnosis of systemic lupus erythematosus and in determining disease activity in Behçet's disease. Med Princ Pract.; 25:510‐516. Zengin O, Onder ME, Kalem A, Bilici M, Türkbeyler I H, Ozturk Z A, Kisacik B, and Onat A M, 2018. New inflammatory markers in early rheumatoid arthritis. Z Rheumatol.; 77:144‐150.

Zhang Y, Yin Y, Kuai S, Shan Z, Pei H, and Wang J., 2016. Combination of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as diagnostic biomarker for rheumatoid arthritis. Int J Clin ExpMed.; 9:22076‐22081.

Publication Date

6-14-2022