Significance of serum albumin and derived neutrophil-to-lymphocyte ratio score in assessment of disease activity in rheumatoid arthritis patients

Abstract

Background: Albumin and derived neutrophil to lymphocyte ratio (dNLR) are known biomarkers that can reflect systemic inflammation and it has been hypothesized that combination of both markers in one score (albumin-dNLR score) can be useful in monitoring rheumatoid arthritis (RA) patients. The current study intended to measure albumin-dNLR score in patients with RA in the order to find whether these new biomarkers could reflect the activity of the disease and the articular activity detected by ultrasonography. We measured serum albumin and dNLR in blood samples obtained from 100 RA patients and from 100 apparently healthy controls (HC). Albumin-dNLR score was calculated according to the presence of hypoalbuminemia (≤ 3.76 gm/dl) and/or raised dNLR (>1.37). Results: RA patients had a significantly elevated dNLR (p< 0.001) and albumin-dNLR score (p< 0.001) compared to their levels in HC, while serum albumin was significantly decreased (p< 0.001) in RA patients than its level in HC. In RA patients, albumin-dNLR score correlated significantly with DAS28 (p< 0.001), erythrocyte sedimentation rate (ESR) (p< 0.001), C-reactive protein (p< 0.001), grey scale (p< 0.001), power Doppler (p< 0.001) and total ultrasound score (p< 0.001). Also, tender joint count, ESR and albumin-dNLR score were significant predictors of DAS28 in multivariate regression analysis. Conclusions: Our study settled that albumin-dNLR score is increased in RA patients than in healthy subjects. The score correlated well with DAS28, acute phase reactants, and ultrasonographic synovitis scores implying that it could be an easy valuable biomarker to monitor RA disease activity.

Serum Albumin Levels: A Biomarker to Be Repurposed in Different Disease Settings in Clinical Practice

“…Decreased serum ALB levels have been extensively described in rheumatoid arthritis (RA), mainly due to suppression of hepatic production by inflammatory cytokines storm, hemodilution and malnutrition status [ 89 ].…”

“…Ganeb S et al (2020) observed that serum ALB levels are significantly lower in RA subjects (median 3.9; 3.5–4.35; p < 0.001) than in healthy controls; moreover, when stratifying RA patients by disease activity, as assessed by Disease Activity Score-28 (DAS28), serum ALB was significantly decreased in patients with high disease activity compared with both those in moderate activity and those in remission [ 89 ].…”

CRP-Albumin Ratio as A Disease Activity Marker in RA Patients, Its Correlation with Musculoskeletal Sonography

“…In our study, serum albumin was marginally lower in our RA patients, with a median of 3.9 (3.5 -5) mg/dl versus 4.4 (3.5-5.5) mg/dl in the controls. Ganeb et al (24) discovered a similar result, with RA patients having reduced blood albumin levels median of 3.9 (3.5-4.35) mg/dl) than controls. Patients with RA have a lower albumin level, as demonstrated by the work of Zhang et al (25) , Ben-Hadj-Mohamed et al (26) , and Tsuji et al (27) since albumin targets inflamed joints, active RA patients commonly develop hypoalbuminemia (6) .…”

Unlocking Potential: Low Bovine Serum Albumin Enhances the Chondrogenicity of Human Adipose-Derived Stromal Cells in Pellet Cultures

“…Furthermore, albumin, being the most abundant protein in the synovial fluid, plays a key role in joint lubrication and the transportation of small molecules in different tissues of the joint [83,84]. Changes in albumin concentrations in the synovial fluid are often associated with inflammatory conditions such as OA or rheumatoid arthritis, with levels typically decreasing, rendering it a potential biomarker in clinical settings [85,86]. The incomplete and controversial information regarding the effect of albumin on chondrogenesis and joint homeostasis needs further investigation into its natural role and variations in healthy and pathologic joints as well as how it may be a potential therapeutic agent.…”