Main Article Content
Abstract
BACKGROUND
Rheumatoid arthritis is a chronic autoimmune disorder that causes joint inflammation, pain and stiffness. Early diagnosis and management of RA can prevent deformities and improve quality of life. This study aims to investigate the correlation between haematological parameters (hemoglobin, mean platelet volume, total platelet count, red cell count, total leukocyte count, neutrophil- lymphocyte ratio or NLR and platelet-lymphocyte ratio or PLR) and DAS-28 (Disease Activity Score-28) in RA patients. Specifically, we are exploring the relationship between NLR, PLR and DAS-28, which has not been extensively studied previously.
METHODS
The study comprised 30 RA (Rheumatoid Arthritis) patients with moderate disease activity and 30 RA patients with high disease activity, aged 40-70 years, and 30 healthy controls. The RA patients were diagnosed according to 2010 American College of Rheumatology criteria, with a minimum disease duration of one year and controlled co-morbidities, including diabetes and hypertension. Data analysis was done by using SPSS software version 24. A p-value <0.05 was taken as statistically significant. Confounding variables like diabetes, hypertension and smoking were adjusted by logistic regression analysis.
RESULTS
Compared to healthy controls, RA patients showed a statistically significant decrease in RBC count and hemoglobin levels, and a significant increase in total leukocyte count, platelet count, mean platelet volume and neutrophil-lymphocyte ratio (p-values: 0.02, <0.001, <0.001, 0.005, <0.001, and 0.045, respectively). Similar statistically significant differences were observed between RA patients with moderate and high disease activity. However, no significant difference was found in platelet-lymphocyte ratio between RA patients and healthy controls.
CONCLUSIONS
Thus, there is a positive association between haematological parameters and disease activity in rheumatoid arthritis patients. NLR can act as an additional tool in identifying people with high disease activity and such people can be given more proactive and intensive care, which can lead to better health outcomes and a decrease in disease-related complications and deaths.
Keywords
Article Details

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References
- Manas T, Gopinath B, Anjan A, et al. A study on association between common haematological parameters, disease activity in RA; Journal of Clinical and Diagnostic Research 2017;11(1): ECO 1-4.
- Okoroiwu IL, Obeagu EI, Obeagu GU. Haemotological variables in RA patients in Imo state Nigeria. Int J Adv Res Biol Sci 2016;3(4):91-98.
- www.arthritis-india.com. http://www.arthritis-india.com/rheumatoid-arthritis.html
- Han C, Rahman MU, Doyle MK, et al. Association of anemia and physical disability among patients with rheumatoid arthritis. The Journal of Rheumatology 2007;34(11):2177-82.
- Furst DE, Chang H, Greenberg JD, et al. Prevalence of low haemoglobin levels and association with other disease parameters in RA patients, evidence from CORRONA registry. Clin Exp Rheumatol 2009;27(4);560-6.
- Nikiphorou E, de Lusignan S, Mallen C, et al. Haematological abnormalities in new-onset rheumatoid arthritis and risk of common infections: a population-based study. Rheumatology 2020;59(5):997-1005. DOI: https://doi.org/10.1093/rheumatology/kez344
- Moghimi J, Ghahremanfard F, Salari M, Ghorbani R. Association between mean platelet volume and severity of rheumatoid arthritis. The Pan African Medical Journal 2017;27:276. DOI: https://doi.org/10.11604/pamj.2017.27.276.12228
- [Visual DAS 28 calculator. http://www.4s-dawn.com/DAS28/.
- Anderson J, Caplan L, Yazdany J, et al. Rheumatoid Arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care Res (Hoboken) 2012;64(5):640-7. DOI: https://doi.org/10.1002/acr.21649
- Zandman-Goddard G, Shoenfeld Y. Ferritin in autoimmune diseases. Autoimmunity Reviews 2007;6:457-63. DOI: https://doi.org/10.1016/j.autrev.2007.01.016
- Singh J, Khattri J. Assessment of prevalence of haematological abnormalities among rheumatoid arthritis patients: an observational study. J Adv Med Dent Scie Res 2019;7(12):165-8.
- Hutchinson RM, Davis P, Jayson MI. Thrombocytosis in rheumatoid arthritis. Annals of the Rheumatic Diseases 1976;35(2):138-42. DOI: https://doi.org/10.1136/ard.35.2.138
- Milovanovic M, Nilsson E, Järemo P. Relationships between platelets and inflammatory markers in rheumatoid arthritis. Clin Chim Acta 2004;343(1-2):237-40. DOI: https://doi.org/10.1016/j.cccn.2003.12.030
- Ertenli I, Kiraz S, Oztürk MA, et al. Pathologic thrombopoiesis of rheumatoid arthritis. Rheumatol Int 2003;23(2):49-60. DOI: https://doi.org/10.1007/s00296-003-0289-0
- Yazici S, Yazici M, Erer B, et al. The platelet indices in patients with rheumatoid arthritis: mean platelet volume reflects disease activity. Platelets 2010;21(2):122-5. DOI: https://doi.org/10.3109/09537100903474373
- Quaiser S, Khan R. Correlation of Neutrophil-Lymphocyte ratio with disease activity in Rheumatoid Arthritis. J Clin Sci 2020;17:46-8. DOI: https://doi.org/10.4103/jcls.jcls_16_18
- Lee JH. Association between platelet count and disease activity in RA patients. J Clin Rheumatol 2019;15(3):143-8.
- Furukawa K. Role of NLR in predicting disease activity in RA patients. Arthritis Res Ther 2020;22(1):1-9.
- Peng YF, Cao L, Zeng YH, et al. Platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in patients with rheumatoid arthritis. Open Medicine 2015;10(1). DOI: https://doi.org/10.1515/med-2015-0037
References
Manas T, Gopinath B, Anjan A, et al. A study on association between common haematological parameters, disease activity in RA; Journal of Clinical and Diagnostic Research 2017;11(1): ECO 1-4.
Okoroiwu IL, Obeagu EI, Obeagu GU. Haemotological variables in RA patients in Imo state Nigeria. Int J Adv Res Biol Sci 2016;3(4):91-98.
www.arthritis-india.com. http://www.arthritis-india.com/rheumatoid-arthritis.html
Han C, Rahman MU, Doyle MK, et al. Association of anemia and physical disability among patients with rheumatoid arthritis. The Journal of Rheumatology 2007;34(11):2177-82.
Furst DE, Chang H, Greenberg JD, et al. Prevalence of low haemoglobin levels and association with other disease parameters in RA patients, evidence from CORRONA registry. Clin Exp Rheumatol 2009;27(4);560-6.
Nikiphorou E, de Lusignan S, Mallen C, et al. Haematological abnormalities in new-onset rheumatoid arthritis and risk of common infections: a population-based study. Rheumatology 2020;59(5):997-1005. DOI: https://doi.org/10.1093/rheumatology/kez344
Moghimi J, Ghahremanfard F, Salari M, Ghorbani R. Association between mean platelet volume and severity of rheumatoid arthritis. The Pan African Medical Journal 2017;27:276. DOI: https://doi.org/10.11604/pamj.2017.27.276.12228
[Visual DAS 28 calculator. http://www.4s-dawn.com/DAS28/.
Anderson J, Caplan L, Yazdany J, et al. Rheumatoid Arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care Res (Hoboken) 2012;64(5):640-7. DOI: https://doi.org/10.1002/acr.21649
Zandman-Goddard G, Shoenfeld Y. Ferritin in autoimmune diseases. Autoimmunity Reviews 2007;6:457-63. DOI: https://doi.org/10.1016/j.autrev.2007.01.016
Singh J, Khattri J. Assessment of prevalence of haematological abnormalities among rheumatoid arthritis patients: an observational study. J Adv Med Dent Scie Res 2019;7(12):165-8.
Hutchinson RM, Davis P, Jayson MI. Thrombocytosis in rheumatoid arthritis. Annals of the Rheumatic Diseases 1976;35(2):138-42. DOI: https://doi.org/10.1136/ard.35.2.138
Milovanovic M, Nilsson E, Järemo P. Relationships between platelets and inflammatory markers in rheumatoid arthritis. Clin Chim Acta 2004;343(1-2):237-40. DOI: https://doi.org/10.1016/j.cccn.2003.12.030
Ertenli I, Kiraz S, Oztürk MA, et al. Pathologic thrombopoiesis of rheumatoid arthritis. Rheumatol Int 2003;23(2):49-60. DOI: https://doi.org/10.1007/s00296-003-0289-0
Yazici S, Yazici M, Erer B, et al. The platelet indices in patients with rheumatoid arthritis: mean platelet volume reflects disease activity. Platelets 2010;21(2):122-5. DOI: https://doi.org/10.3109/09537100903474373
Quaiser S, Khan R. Correlation of Neutrophil-Lymphocyte ratio with disease activity in Rheumatoid Arthritis. J Clin Sci 2020;17:46-8. DOI: https://doi.org/10.4103/jcls.jcls_16_18
Lee JH. Association between platelet count and disease activity in RA patients. J Clin Rheumatol 2019;15(3):143-8.
Furukawa K. Role of NLR in predicting disease activity in RA patients. Arthritis Res Ther 2020;22(1):1-9.
Peng YF, Cao L, Zeng YH, et al. Platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in patients with rheumatoid arthritis. Open Medicine 2015;10(1). DOI: https://doi.org/10.1515/med-2015-0037