Neutrophil‐to‐Lymphocyte Ratio and Platelet‐to‐Lymphocyte Ratio as Biomarkers in Axial Spondyloarthritis: Observational Studies From the Program to Understand the Longterm Outcomes in Spondyloarthritis Registry

Abstract

Objectives This study was conducted to assess the utility of neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) in predicting radiographic sacroiliitis and active disease in axial spondyloarthritis (SpA) and to explore the association between use of a tumor necrosis factor inhibitor (TNFi) and these laboratory values compared with traditional inflammatory markers. Methods Observational data from the Program to Understand the Longterm Outcomes in Spondyloarthritis (PULSAR) registry were analyzed. We generated receiver operating characteristic curves to calculate laboratory cutoff values; we used these values in multivariable logistic regression models to identify associations with radiographically confirmed sacroiliitis and active disease. We also used logistic regression to determine the likelihood of elevated laboratory values after initiation of TNFi. Results Most study participants (n = 354) were White, male, and HLA–B27 positive. NLR (odds ratio [OR] 1.459, P = 0.034), PLR (OR 4.842, P < 0.001), erythrocyte sedimentation rate (OR 4.397, P < 0.001), and C‐reactive protein (CRP) level (OR 2.911, P = 0.001) were independent predictors of radiographic sacroiliitis. Models that included PLR with traditional biomarkers performed better than those with traditional biomarkers alone. NLR (OR 6.931, P = 0.002) and CRP (OR 2.678, P = 0.004) were predictors of active disease, but the model that included both NLR and CRP performed better than CRP alone. TNFi use reduced the odds of elevated NLR (OR 0.172, P < 0.001), PLR (OR 0.073, P < 0.001), erythrocyte sedimentation rate (OR 0.319, P < 0.001), and CRP (OR 0.407, P < 0.001), but models that included NLR or PLR and traditional biomarkers performed best. Conclusions These findings demonstrate an association between NLR and PLR and sacroiliitis and disease activity, with NLR and PLR showing response after TNFi treatment and adding useful clinical information to established biomarkers, thus perhaps assisting in management of axial SpA.

Association of serum platelet-to-lymphocyte ratio levels with the risk of stent thrombosis and long-term prognosis in patients undergoing percutaneous coronary intervention with and without type 2 diabetes mellitus: a large-scale prospective cohort study

“…PLR is an easy-to-obtained inflammatory biomarker calculated as the ratio of the platelet to lymphocyte count. Previous studies had applied PLR in several inflammatory disorder conditions, including solid tumors 17 , arthritis 18 , and acute kidney injury 19 . These studies indicated PLR could be a useful biomarker to indicate the disease activity, treatment reaction, and prognosis.…”

The role of NETosis in the pathogenesis of immunoinflammatory rheumatic diseases

“…Костное воспаление, выявляемое в крестцово-подвздошных сочленениях у пациентов с ранним СпА и у трансгенных крыс, экспрессирующих HLA-B27, характеризуется выраженным нейтрофильным компонентом [186,187]. В крови пациентов с АС наблюдается увеличение уровня нейтрофилов, ассоциирующееся с прогрессированием поражения позвоночника [188]. Активация оси ИЛ-23/ИЛ-17 приводит к рекрутированию и активации нейтрофилов, связанных с синтезом ИЛ-8 [189,190].…”

Which inflammatory marker might be the best indicator for sacroiliitis?

“…Similarly, it has been reported that a high initial CLR ratio detected in COVID‐19 patients is a predictor of poor prognosis 14 . Rouhin Sen and colleagues have reported a relationship between NLR and PLR in predicting radiographic sacroiliitis and active disease in axial spondyloarthritis (SpA), which could assist in the management of SpA when evaluated in conjunction with clinical findings 15 …”

“…14 Rouhin Sen and colleagues have reported a relationship between NLR and PLR in predicting radiographic sacroiliitis and active disease in axial spondyloarthritis (SpA), which could assist in the management of SpA when evaluated in conjunction with clinical findings. 15 However, to our knowledge, these inflammatory markers have not been collectively evaluated in sacroiliitis. Therefore, our aim was to investigate inflammatory markers (PLR, NLR, LMR, CLR) in patients with and without sacroiliitis, and also to evaluate the differences in these markers between active and chronic sacroiliitis patients.…”