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
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Clinical and Laboratory Findings
2.3. Ultrasound Imaging of Joints
- Semi-quantitative grey scale (GS) for grading synovial hypertrophy (0–3) in each joint:
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- Grade 0: normal joint with no synovial hypertrophy;
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- Grade 1: synovial hypertrophy up to the level of the horizontal line connecting the bone surfaces of an examined joint;
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- Grade 2: synovial hypertrophy extending beyond the joint line but with the upper surface flat to the underlying bones;
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- Grade 3: synovial hypertrophy extending beyond the joint line but with the upper surface convex to the underlying bones.
- Power Doppler ultrasound (PDUS) semi-quantitative scale (0–3) in each joint:
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- Grade 0: no Doppler activity;
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- Grade 1: up to three single Doppler spots, or up to one confluent spot and two single spots, or up to two confluent spots;
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- Grade 2: greater than grade 1 but <50% Doppler signals in the total GS background;
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- Grade 3: greater than grade 2 and >50% Doppler signals of the GS background [20].
2.4. Statistical Analysis
3. Results
3.1. Demographic and Disease-Related Variables in RA Patients
3.2. Relationship between NLR, PLR, LMR, and Ultrasound Disease Activity Markers
3.3. The Relationship between Ultrasound and Other Disease Activity Markers
3.4. The Relationship between NLR, PLR, LMR, and Clinical Disease Activity Markers
3.5. The Relationship between NLR, PLR, LMR, and Laboratory Disease Activity Markers
3.6. A Comparison of NLR, PLR, and LMR in Certain Groups of RA Patients
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Data | Results (Mean (SD) (Range) or Number (%)) |
---|---|
Age, years | 53.8 (11.9) (20–82) |
Gender, female/male | 100 (79.4)/26 (20.6) |
RA related variables: | |
Disease duration, years | 14.0 (10.9) (1–45) |
Positive RF-IgM | 110 (87.3) |
Positive anti-CCP | 104 (82.5) |
Extra-articular manifestations | 70 (55.6) |
Erosions (hands/feet) | 107 (84.9) |
M-HAQ | 1.4 (0.7) (0–3.5) |
Current conventional DMARD | 124 (98.4) |
Current biological treatment | 62 (49.2) |
Current glucocorticoid use | 83 (65.9) |
Laboratory results: | |
Hemoglobin, g/dL | 12.8 (1.4) (9.4–16.1) |
White blood cells | 6.9 (2.4) (3.2–14.6) |
Platelets, 109/L | 289.2 (78.2) (124–505) |
Neutrophils, 109/L | 4.6 (2.4) (1.1–12.9) |
Lymphocytes, 109/L | 1.6 (0.6) (0.6–4.2) |
Monocytes, 109/L | 0.4 (1.8) (0.1–1.5) |
NLR | 3.34 (2.4) (0.5–14.0) |
PLR | 204.5 (95.9) (71.2–600) |
LMR | 4.4 (2.5) (1.2–15.8) |
CRP, mg/L | 15.0 (18.7) (0.6–85.0) |
ESR, mm/h | 35.3 (28.3) (2–120) |
Clinical parameters of RA activity: | |
TJC | 5.5 (5.5) (0–21) |
SJC | 3.7 (4.4) (0–19) |
PGA (VAS), mm | 37.6 (26.0) (0–98) |
Morning stiffness, minutes | 56.1 (63.1) (0–300) |
DAS28 | 4.19 (1.8) (0.7–7.8) |
Low disease activity (DAS28 < 3.2) | 45 (35.7) |
GSUS score (hypertrophy) | 16.5 (13.2) (0–60) |
PDUS score | 3.3 (5.8) (0–42) |
Global score | 19.8 (17.6) (0–87) |
Data/p Value/R | CRP | ESR | DAS28 | TJC | SJC | PGA | Morning Stiffness | M-HAQ | WBC Count | Hb |
---|---|---|---|---|---|---|---|---|---|---|
NLR | <0.001 | <0.001 | <0.001 | 0.004 | 0.001 | 0.003 | 0.006 | 0.03 | <0.001 | NS |
0.5 | 0.37 | 0.37 | 0.26 | 0.3 | 0.26 | 0.27 | 0.2 | 0.54 | ||
PLR | <0.001 | <0.001 | <0.001 | 0.003 | 0.002 | 0.02 | 0.04 | NS | NS | 0.005 |
0.31 | 0.35 | 0.35 | 0.26 | 0.28 | 0.22 | 0.21 | −0.25 | |||
LMR | 0.02 | NS | NS | NS | NS | NS | NS | NS | NS | NS |
−0.21 | ||||||||||
GSUS score | 0.02 | 0.006 | <0.001 | 0.007 | <0.001 | <0.001 | 0.05 | NS | NS | NS |
0.21 | 0.25 | 0.36 | 0.24 | 0.47 | 0.34 | 0.2 | ||||
PDUS score | <0.001 | 0.002 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | 0.02 | NS | NS |
0.31 | 0.27 | 0.42 | 0.36 | 0.6 | 0.39 | 0.38 | 0.22 | |||
Global score | 0.007 | 0.003 | <0.001 | 0.002 | <0.001 | <0.001 | 0.01 | 0.04 | NS | NS |
0.24 | 0.27 | 0.4 | 0.28 | 0.52 | 0.36 | 0.25 | 0.2 |
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Targońska-Stępniak, B.; Zwolak, R.; Piotrowski, M.; Grzechnik, K.; Majdan, M. 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. J. Clin. Med. 2020, 9, 2760. https://doi.org/10.3390/jcm9092760
Targońska-Stępniak B, Zwolak R, Piotrowski M, Grzechnik K, Majdan M. 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. Journal of Clinical Medicine. 2020; 9(9):2760. https://doi.org/10.3390/jcm9092760
Chicago/Turabian StyleTargońska-Stępniak, Bożena, Robert Zwolak, Mariusz Piotrowski, Krzysztof Grzechnik, and Maria Majdan. 2020. "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" Journal of Clinical Medicine 9, no. 9: 2760. https://doi.org/10.3390/jcm9092760