Potential of neutrophil to lymphocyte ratio in predicting sustained remission in rheumatoid arthritis compared to other immune activation markers

Abstract

Background & objectives : Cells and cell proportions may indicate the equilibrium status of the immune system. The present study was conducted to evaluate the role of cytokines and the immunocompetent cells as biomarkers of remission in rheumatoid arthritis (RA) patients intended to withdraw or reduce disease-modifying anti-rheumatic drug (DMARD) treatment. Methods : This prospective observational study involved newly diagnosed and treated RA patients who fulfilled 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria. The patients were classified based on disease activity score (DAS)28-C-reactive protein (CRP)(3) score into remission (≤2.6) and treatment-naïve/active (>2.6) groups. Remission patients were followed up for six months and were reclassified into those in sustained remission (≤2.6) and relapse (>2.6) based on the DAS28-CRP(3) score. Various cytokines and cell surface markers were quantitated using whole blood samples, and the CD3 + /CD19 + and FOXP3 + /CD4 + ratios were calculated. The clinical, demographic, cytokine and cellular phenotype characteristics were compared between remission and treatment-naïve groups. The factors associated with sustained remission were verified. Results : Of the 72 patients, 52 were in remission and 20 were DMARD naïve and had active disease. Duration of illness, interleukin-6 (IL-6) and IL-10 were significantly different between remission and treatment naïve/active disease patients. Increased likelihood for achieving sustained remission was noted in RA patients with baseline NLR ≤2. Other demographic/clinical variables and cell phenotypes, namely age, gender, duration of illness, CD3 + , CD4 + , FOXP3 + , CD19 + , CD3 + /CD19 + , FOXP3 + /CD4 + and cytokines - IL-6 and IL-10 were not associated with sustained remission. Interpretation & conclusions : The present preliminary study highlighted the potential of NLR in predicting sustained remission in RA patients with a cut-off <2. Further study with a large sample size should be done to confirm this finding.

Potential Biological Molecules and Immune Cell for Rheumatoid Arthritis Synovial Lesions

“…We also obtained some immune cell related to RA synovial lesions. Compared with other immune activation markers, neutrophils are at the center of RA pathology (31) The ratio of neutrophils to lymphocytes has great potential in predicting sustained remission of RA (32). Plasmacytoid dendritic cells participate in the local in ammatory environment of RA (33).…”

Neutrophil‐to‐lymphocyte and platelet‐to‐lymphocyte ratio and disease activity in rheumatoid arthritis: A systematic review and meta‐analysis

“…All studies reported NLR values, whereas 11 also reported PLR values (Table 1). [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] There was no disagreement between the two investigators.…”

“…Eighteen studies investigated the NLR in 2122 RA patients with active disease (mean age 50 years, 20% males) and 1071 RA patients in remission (mean age 50 years, 25% males). [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] Five studies were conducted in China, 29,31,33,40,41 four in Turkey, [26][27][28]34 four in India, 25,30,35,36 two in Egypt, 32,42 and one in the Philippines, 37 Poland 38 and Thailand, 39 respectively. Eight studies were prospective, 25,27,29,30,35,36,38,42 whereas the remaining 10 were retrospective.…”

“…[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] Five studies were conducted in China, 29,31,33,40,41 four in Turkey, [26][27][28]34 four in India, 25,30,35,36 two in Egypt, 32,42 and one in the Philippines, 37 Poland 38 and Thailand, 39 respectively. Eight studies were prospective, 25,27,29,30,35,36,38,42 whereas the remaining 10 were retrospective. 26,28,[31][32][33][34]37,…”

Role of Systemic Inflammatory Reaction in Female Genital Organ Malignancies – State of the Art

“…31 It must be emphasized, however, that increased systemic inflammation is not pathognomonic solely for malignancies. Increased SIR is predominately observed in autoimmune diseases including rheumatoid arthritis, [32][33][34] spondyloarthropathies, 35,36 Crohn's disease, 37 diabetes, 38 and Hashimoto's thyroiditis 39 and has even been reported in patients with COVID-19. 40 Furthermore, multiple demographic and lifestyle factors, including sex, age, race, marital status, body mass index, physical activity, smoking history, and alcohol consumption are independently associated with inflammatory biomarkers; these should be also taken in consideration to more accurately assess their prognostic power.…”