The Relationship between Hematological Markers of Systemic Inflammation (Neutrophil-To-Lymphocyte, Platelet-To-Lymphocyte, Lymphocyte-To-Monocyte Ratios) and Ultrasound Disease Activity Parameters in Patients with Rheumatoid Arthritis

Abstract

Background: An accurate measurement of disease activity is essential for the appropriate management of a patient with rheumatoid arthritis (RA). Hematological markers of systemic inflammation (Neutrophil-to-Lymphocyte (NLR), Platelet-to-Lymphocyte (PLR) and Lymphocyte-to-Monocyte (LMR) ratios) are reported to be novel, sensitive measures of inflammatory response, in addition to conventional markers (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Disease Activity Score (DAS28)). The goal of the study was to assess the relationship of NLR, PLR, and LMR with ultrasonography (US) parameters of disease activity in RA patients. Methods: The study group consisted of 126 consecutive RA patients (100 women, 26 men). The following assessments were performed: joint counts, DAS28, complete blood cell counts, ESR, CRP, and US of 24 small joints. Results: NLR and PLR were significantly positively correlated with all US parameters of disease activity (Grey Scale US, Power Doppler US, and Global scores). The mean values of NLR and PLR were significantly higher in patients with poor prognostic factors: moderate/high vs. low disease activity (NLR: p < 0.001; PLR: p = 0.007), anti-CCP positive vs. anti-CCP negative (NLR: p = 0.01; PLR: p = 0.006). In multiple regression tests, significant correlations were confirmed for: NLR and DAS28 (p = 0.04), and CRP (p = 0.001); PLR and Power Doppler US (p = 0.04), and ESR (p = 0.02). No correlation was found for LMR. Conclusion: NLR and PLR are associated with US disease activity parameters and may serve as reliable, inexpensive markers, with prognostic significance in RA.

Elevated Monocyte to Lymphocyte Ratio and Increased Mortality among Patients with Chronic Kidney Disease Hospitalized for COVID-19

“…High levels of blood biomarkers such as NLR, PLR, and MLR have been reported in certain inflammatory conditions, including various types of infections [ 23 , 25 , 26 ]. Notably, in comparison with previous data from a study that included 500 healthy individuals with a similar background (Hispanic population), whose normal values are as follow: PLR, mean SD 125.4 ± 36.3, median 120; NLR, mean SD 1.80 ± 0.65, median 1.70; and MLR, mean SD 0.23 ± 0.07, median 0.21 [ 24 ], the levels of these three inflammatory markers (NLR, MLR, and PLR) among the hospitalized patients included in this study were considerably higher ( Table 3 ).…”

“…In addition, in patients with CKD, an array of immune dysfunctions have been documented. This includes and impaired function of T and B lymphocytes and a lower phagocytic activity of neutrophils and macrophages [ 23 , 24 ]. Furthermore, patients with CKD requiring renal replacement therapy, repeated dialysis sessions may expose them to a possible contaminated environment.…”

“…However, when assessing their potential impact on patients’ survival, only an elevation in MLR consistently correlated with increased mortality among patients with CKD but not in those without CKD. Since NLR, MLR, and PLR can be easily calculated from blood cell counts, these parameters have been used as potential surrogate biomarkers in several infectious and inflammatory conditions [ 23 ]. In particular, an increased monocyte to lymphocyte ratio (MLR) has been reported in association with several types of infection [ 25 ], autoimmune disorders [ 35 ], acute and chronic cardiovascular events [ 36 ], and cancer [ 37 ].…”

“…The following parameters were further calculated based on leukocyte counts. Neutrophils to lymphocytes ratio (NLR), was calculated by dividing the absolute neutrophil count (ANC) by the absolute lymphocyte count (ALC); monocyte to lymphocyte ratio (MLR) was determined by dividing the absolute monocyte count (AMC) by the ALC, and the platelet to lymphocyte ratio (PLR) was calculated by dividing the absolute platelet count (APC) by ALC, as described before [ 23 , 24 ]. Additional blood examinations included liver function tests, ferritin, magnesium, C-reactive protein, lactate dehydrogenase, D-dimer, and procalcitonin, although these parameters were not available in all patients.…”

Systemic Inflammatory Parameters in Patients with Elderly-Onset Rheumatoid Arthritis (EORA) and Young-Onset Rheumatoid Arthritis (YORA)—An Observational Study

“…In the last few years, hematological parameters of systemic inflammation (the Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte ratio (PLR) have come into use. They have been reported to be sensitive measures of inflammation in different fields of medicine: oncology, diabetes, cardiology, nephrology, infectious diseases, and autoimmune rheumatic diseases, including RA [ 7 , 8 , 9 , 10 , 11 ]. Research found that NLR and PLR correlate with different parameters of RA activity (laboratory, clinical, and ultrasound) and may serve as reliable markers of RA systemic activity.…”