HALP score and disease activity in psoriatic arthritis: Comparison with healthy controls

Year 2025, EARLY ONLINE, 1 - 8

Sezgin Zontul , Servet Yolbaş , Elif İnanç , Emrah Şimşek , Ahmet Kadir Arslan

https://doi.org/10.18621/eurj.1799369

Abstract

Objectives: This study evaluated the relationship between the haemoglobin-albumin-lymphocyte-platelet (HALP) score and disease activity in patients with psoriatic arthritis (PsA), and compared HALP scores between PsA patients and healthy controls.

Methods: This single-centre, cross-sectional study included 73 PsA patients and 59 healthy controls. Demographic, clinical and laboratory data were collected. Disease activity was assessed using the Ankylosing Spondylitis Disease Activity Score (ASDAS) based on C-reactive protein (CRP), the Disease Activity index for Psoriatic Arthritis (DAPSA), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the visual analogue scale (VAS), and the Psoriasis Area and Severity Index (PASI). HALP was calculated as haemoglobin × albumin × lymphocyte / platelet. Group comparisons, correlation analyses and ROC analyses were performed.

Results: Compared with controls, PsA patients had higher CRP, erythrocyte sedimentation rate and platelet values, and lower albumin (all P<0.05). HALP scores did not differ significantly between groups (P=0.232). HALP correlated positively with age at diagnosis (r = 0.250; P=0.031) and negatively with ASDAS-CRP (r = −0.259; P=0.026). ROC analysis showed limited diagnostic performance (AUC = 0.561, P=0.228).

Conclusions: Although HALP showed a significant inverse correlation with ASDAS-CRP, the association was weak and its diagnostic performance was poor. HALP alone has limited value in reflecting PsA disease activity or distinguishing patients from controls. This may relate to PsA’s heterogeneous inflammation and treatment status. Larger prospective studies in different PsA subgroups are needed to clarify the potential role of HALP as an objective biomarker.

Keywords

Psoriatic arthritis , HALP score , inflammation , biomarker , disease activity

Ethical Statement

This study was approved by the the İnönü University Scientific Research and Publication Ethics Committee (Decision No: 2025/7251; date: 11.03.2025). All procedures were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Written informed consent was obtained from all participants prior to inclusion in the study.

References

• 1. Veale DJ, Fearon U. The pathogenesis of psoriatic arthritis. Lancet. 2018;391(10136):2273-2284. doi: 10.1016/S0140-6736(18)30830-4.
• 2. FitzGerald O, Ogdie A, Chandran V, et al. Psoriatic arthritis. Nat Rev Dis Primers. 2021 Aug 12;7(1):59. doi: 10.1038/s41572-021-00293-y.
• 3. Ocampo D V, Gladman D. Psoriatic arthritis. F1000Res. 2019;8:F1000 Faculty Rev-1665. doi: 10.12688/f1000research.19144.1.
• 4. Coates LC, Moverley AR, McParland L, et al. Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open-label, randomised controlled trial. Lancet. 2015;386(10012):2489-2498. doi: 10.1016/S0140-6736(15)00347-5.
• 5. Kerschbaumer A, Smolen JS, Aletaha D. Disease activity assessment in patients with psoriatic arthritis. Best Pract Res Clin Rheumatol. 2018;32(3):401-414. doi: 10.1016/j.berh.2018.08.004.
• 6. Schoels M, Aletaha D, Funovits J, Kavanaugh A, Baker D, Smolen JS. Application of the DAREA/DAPSA score for assessment of disease activity in psoriatic arthritis. Ann Rheum Dis. 2010;69(8):1441-1447. doi: 10.1136/ard.2009.122259.
• 7. Helliwell PS, FitzGerald O, Fransen J, et al. The development of candidate composite disease activity and responder indices for psoriatic arthritis (GRACE project). Ann Rheum Dis. 2013;72(6):986-991. doi: 10.1136/annrheumdis-2012-201341.
• 8. Coates LC, Fransen J, Helliwell PS. Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis. 2010;69(1):48-53. doi: 10.1136/ard.2008.102053.
• 9. Mercan R, Bitik B, Tufan A, et al. The Association Between Neutrophil/Lymphocyte Ratio and Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis. J Clin Lab Anal. 2016;30(5):597-601. doi: 10.1002/jcla.21908.
• 10. Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD. The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases. Ann Lab Med. 2019;39(4):345-357. doi: 10.3343/alm.2019.39.4.345.
• 11. Varkal G, Türk I, Yetişir A, Ağbuga ÖD, Mete B, Özbek S. The Relationship Between the Monocyte-to-High-Density Lipoprotein-Cholesterol Ratio and Disease Activity in Patients with Psoriatic Arthritis. Eur J Rheumatol. 2025;12(2):1-5. doi: 10.5152/eurjrheum.2025.24052.
• 12. Farag CM, Antar R, Akosman S, Ng M, Whalen MJ. What is hemoglobin, albumin, lymphocyte, platelet (HALP) score? A comprehensive literature review of HALP's prognostic ability in different cancer types. Oncotarget. 2023;14:153-172. doi: 10.18632/oncotarget.28367.
• 13. Marín-Corte JA, Castillo-Sigales AA, Fragoso-Loyo H, Cimé-Aké E. HALP Score for Predicting Renal Relapse in Lupus Nephritis: A Nested Case-Control Study. J Clin Rheumatol. 2025;31(7):e158-e165. doi: 10.1097/RHU.0000000000002244.
• 14. Cüre O. Association between disease activity and HALP score in ankylosing spondylitis patients. Eur Res J. 2025;11(2):251-259. doi:10.18621/eurj.1609765.
• 15. Fan M, Zhang L, Yin Q, Bao F, Zhou Y, Zhao E. Association between hemoglobin albumin lymphocyte and platelet (HALP) score and psoriasis: Evidence from NHANES. J Natl Med Assoc. 2025 Sep 4:S0027-9684(25)00299-8. doi: 10.1016/j.jnma.2025.08.099.
• 16. Schulze-Koops H. Lymphopenia and autoimmune diseases. Arthritis Res Ther. 2004;6(4):178-180. doi: 10.1186/ar1208.
• 17. Scherlinger M, Richez C, Tsokos GC, Boilard E, Blanco P. The role of platelets in immune-mediated inflammatory diseases. Nat Rev Immunol. 2023;23(8):495-510. doi: 10.1038/s41577-023-00834-4.
• 18. Chen XL, Xue L, Wang W, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015;6(38):41370-41382. doi: 10.18632/oncotarget.5629.
• 19. Arslan AK, Yaşar Ş, Çolak C, Yoloğlu S. WSSPAS: an interactive web application for sample size and power analysis with R using Shiny. Turkiye Klin J Biostat. 2018;10(3):224-246. doi: 10.5336/biostatic.2018-62787.
• 20. Xin Y, Wang Y, Shu Y, Liang H, Yang Y. Hemoglobin, albumin, lymphocyte, and platelet (HALP) score predict prognosis in patients with atrial fibrillation and acute coronary syndrome or undergoing percutaneous coronary intervention. BMC Cardiovasc Disord. 2025;25(1):507. doi: 10.1186/s12872-025-04968-2.
• 21. Huang L, Li X, Zhou W, et al. The Clinical Value of the Neutrophil-to-Lymphocyte Ratio, the C-Reactive Protein-to-Albumin Ratio, the Systemic Inflammatory Index, and the Systemic Inflammatory Response Index in Patients with the Anti-Synthetase Syndrome. J Inflamm Res. 2024;17:3617-3628. doi: 10.2147/JIR.S460610.
• 22. Coşkun BN, Öksüz MF, Ermurat S, et al. Neutrophil lymphocyte ratio can be a valuable marker in defining disease activity in patients who have started anti-tumor necrosis factor (TNF) drugs for ankylosing spondylitis. Eur J Rheumatol. 2014;1(3):101-105. doi: 10.5152/eurjrheumatol.2014.034.
• 23. Germolec DR, Shipkowski KA, Frawley RP, Evans E. Markers of Inflammation. Methods Mol Biol. 2018;1803:57-79. doi: 10.1007/978-1-4939-8549-4_5.
• 24. Tian M, Li Y, Wang X, et al. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score Is Associated With Poor Outcome of Acute Ischemic Stroke. Front Neurol. 2021;11:610318. doi: 10.3389/fneur.2020.610318.
• 25. Xu SS, Li S, Xu HX, et al. Haemoglobin, albumin, lymphocyte and platelet predicts postoperative survival in pancreatic cancer. World J Gastroenterol. 2020;26(8):828-838. doi: 10.3748/wjg.v26.i8.828.
• 26. Veale JD, Gorman Á, Veale DJ, Fearon U, Orr C, Marzaioli V. Investigation of serum biomarkers in rheumatoid and psoriatic arthritis patients for disease-specific signatures. Arthritis Res Ther. 2025;27(1):147. doi: 10.1186/s13075-025-03608-6.
• 27. Kim DS, Shin D, Lee MS, et al. Assessments of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in Korean patients with psoriasis vulgaris and psoriatic arthritis. J Dermatol. 2016;43(3):305-310. doi: 10.1111/1346-8138.13061.
• 28. Asahina A, Kubo N, Umezawa Y, Honda H, Yanaba K, Nakagawa H. Neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and mean platelet volume in Japanese patients with psoriasis and psoriatic arthritis: Response to therapy with biologics. J Dermatol. 2017;44(10):1112-1121. doi: 10.1111/1346-8138.13875.
• 29. Kılınç EA, Varkal G, Kırmızıer G, Türk İ, Özer HTE. Are monocyte-to-HDL and C-reactive protein-to-albumin ratios useful for the diagnosis and follow-up of Takayasu arteritis? Rev Assoc Med Bras (1992). 2024;70(5):e20231683. doi: 10.1590/1806-9282.20231683.