Is Serum C- Reactive Protein to Albumin Ratio Be A New Biomarker for Assessing Disease Activity and Quality of Life in Rheumatoid Arthritis?

Öz

The C-reactive protein (CRP)/albumin ratio is a biomarker that has gained importance in recent years in demonstrating systemic inflammation. The aim of this study was to evaluate the relationship of CRP/albumin ratio with disease activity and quality of life in patients with rheumatoid arthritis (RA). Fifty RA patients were included in this cross-sectional study. The CRP/albumin ratio was calculated from the blood of the individuals included in the study. The disease activity score-28 (DAS-28) measurement scale was used to determine disease activity. The Health Assessment Questionnaire (HAQ) was used to assess functional status, and the Short-form health survey 36 (SF-36) was used to assess the quality of life. When the patients were evaluated according to the disease activity level, the CRP/albumin ratio was statistically significantly higher in patients with moderate-high disease activity compared to those in remission in post-hoc analyses (p=0.006). In correlation analyzes, moderate and positive correlation (p=0.002, rs= 0.426; p<0.001, rs= 0.536, respectively) was observed between CRP/albumin ratio and erythrocyte sedimentation rate (ESR) and DAS 28-ESR scores. When the patients were evaluated according to the drug treatments they received, no significant difference was observed between conventional DMARD and biological DMARD users in terms of CRP/albumin ratio, SF-36, and HAQ scores (p>0.05). Our results suggest that CAR may be used in clinics to determine inflammation and disease activity as an inexpensive and easily applicable biomarker.

Anahtar Kelimeler

• C-reactive protein
• albumin
• rheumatoid arthritis
• disease activity

Serum C- Reaktif Protein/Albumin Oranı, Romatoid Artritte Hastalık Aktivitesini ve Yaşam Kalitesini Değerlendirmek için Yeni Bir Belirteç Olabilir Mi?

Öz

Serum C- reaktif protein /albumin oranı Romatoid Artritte sistemik inflamasyonu göstermede son yıllarda önem kazanan bir biyobelirteçtir. Bu çalışmanın amacı Romatoid artritli (RA) hastalarda CRP/ albumin oranının hastalık aktivitesi ve hayat kalitesi ile olan ilişkisini değerlendirmektir. Bu kesitsel çalışmaya 50 RA hastası dahil edilmiştir. Çalışmaya alınan bireylerin kanlarından CRP/ albumin oranı hesaplandı. Hastalık aktivitesini tayin etmek amacıyla hastalık aktivite skoru (DAS-28) ölçüm skalası kullanıldı. Fonksiyonel durum değerlendirmedi için Sağlık değerlendirme anketi (HAQ) anketi, yaşam kalitesini değerlendirmek için de Kısa-form 36 (SF-36) anketi kullanıldı. Hastalar, post-hoc analizlerde hastalık aktivite düzeyine göre değerlendirildiğinde hastalık aktivitesi orta-yüksek olanlarda CRP/albumin oranının remisyondakilere oranla istatistiksel olarak anlamlı oranda yüksek olduğu gözlendi (p=0.006). Korelasyon analizlerinde CRP/ albumin oranı ile eritrosit sedimentasyon hızı (ESR) ve DAS 28-ESR skorları arasında ılımlı ve pozitif yönde korelasyon (p=0.002, rs= 0.426; p<0.001, rs= 0.536, sırasıyla) izlendi. Hastalar aldıkları ilaç tedavilerine göre değerlendirildiğinde konvansiyonel hastalık modifiye edici anti-romatizmal ilaç (DMARD) ve biyolojik DMARD alanlar arasında CRP/albumin oranı, SF-36 ve HAQ skorları açısından anlamlı fark izlenmedi (p>0.05). Çalışmamızın sonuçları, ucuz ve kolay uygulanabilir bir biyobelirteç olarak CRP/ albumin oranının kliniklerde inflamasyon ve hastalık aktivitesini belirlemek için kullanılabileceğini düşündürmektedir.

Anahtar Kelimeler

• C- reaktif protein
• albumin
• romatoid artrit
• hastalık aktivitesi

Kaynakça

1. 1. Goldring SR. Periarticular bone changes in rheumatoid arthritis: pathophysiological implications and clinical utility. Ann Rheum Dis.2009;68(3):297-9.
2. 2. Fardellone P, Séjourné A, Paccou J, Goëb V. Bone remodelling markers in rheumatoid arthritis. Mediators Inflamm. 2014;2014:484280.
3. 3. Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, van Zeben D, Kerstens PJ, Hazes JM, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum.2005;52(11):3381-90.
4. 4. Buzatu C, Moots RJ. Measuring disease activity and response to treatment in rheumatoid arthritis. Expert Rev Clin Immunol. 2019;15(2):135-45.
5. 5. Aletaha D, Funovits J, Breedveld FC, Sharp J, Segurado O, Smolen JS. Rheumatoid arthritis joint progression in sustained remission is determined by disease activity levels preceding the period of radiographic assessment. Arthritis Rheum.2009;60(5):1242-9.
6. 6. Nakken B, Papp G, Bosnes V, Zeher M, Nagy G, Szodoray P. Biomarkers for rheumatoid arthritis: From molecular processes to diagnostic applications-current concepts and future perspectives. Immunology Lett. 2017;189:13-8.
7. 7. Colglazier CL, Sutej PG. Laboratory testing in the rheumatic diseases: a practical review. South Med J.2005;98(2):185-91.
8. 8. Yang WM, Zhang WH, Ying HQ, Xu YM, Zhang J, Min QH, et al. Two new inflammatory markers associated with disease activity score-28 in patients with rheumatoid arthritis: Albumin to fibrinogen ratio and C-reactive protein to albumin ratio. Int Immunopharmacol. 2018;62:293-8.

9. 9. He Y, Tang J, Wu B, Yang B, Ou Q, Lin J. Correlation between albumin to fibrinogen ratio, C-reactive protein to albumin ratio and Th17 cells in patients with rheumatoid arthritis. Clin Chim Acta. .2020;500:149-54.
10. 10. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569-81.
11. 11. Fransen J, van Riel PL. The Disease Activity Score and the EULAR response criteria. Rheum Dis Clin North Am.2009;35(4):745-57.
12. 12. Aletaha D, Ward MM, Machold KP, Nell VP, Stamm T, Smolen JS. Remission and active disease in rheumatoid arthritis: defining criteria for disease activity states. Arthritis Rheum. 2005;52(9):2625-36.
13. 13. Küçükdeveci AA, Sahin H, Ataman S, Griffiths B, Tennant A. Issues in cross-cultural validity: example from the adaptation, reliability, and validity testing of a Turkish version of the Stanford Health Assessment Questionnaire. Arthritis Rheum. 2004;51(1):14-9.
14. 14. Ware JE, Jr., Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care.1995;33(4 Suppl):As264-79.
15. 15. Oh TK, Song IA, Lee JH. Clinical usefulness of C-reactive protein to albumin ratio in predicting 30-day mortality in critically ill patients: A retrospective analysis. Sci Rep. 2018;8(1):14977.
16. 16. Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PloS one. 2013;8(3):e59321.
17. 17. Seringec Akkececi N, Yildirim Cetin G, Gogebakan H, Acipayam C. The C-Reactive Protein/Albumin Ratio and Complete Blood Count Parameters as Indicators of Disease Activity in Patients with Takayasu Arteritis. Med Sci Monit. 2019;25:1401-9.
18. 18. Sunar İ, Ataman Ş. Serum C-Reactive Protein/Albumin Ratio in Rheumatoid Arthritis and its Relationship With Disease Activity, Physical Function, and Quality of Life. Arch Rheumatol. 2020;35(2):247-53.
19. 19. Zou Y-X, Qiao J, Zhu H-Y, Lu R-N, Xia Y, Cao L, et al. Albumin-to-fibrinogen ratio as an independent prognostic parameter in untreated chronic lymphocytic leukemia: a retrospective study of 191 cases. Cancer Res Treat. 2019;51(2):664.
20. 20. Shimizu T, Ishizuka M, Suzuki T, Tanaka G, Shiraki T, Sakuraoka Y, et al. The Value of the C-Reactive Protein-to-Albumin Ratio is Useful for Predicting Survival of Patients with Child-Pugh Class A Undergoing Liver Resection for Hepatocellular Carcinoma. World J Surg. 2018;42(7):2218-26.
21. 21. Barber MD, Ross JA, Fearon KC. Changes in nutritional, functional, and inflammatory markers in advanced pancreatic cancer. Nutr Cancer. 1999;35(2):106-10.
22. 22. Hayashi S, Matsubara T, Fukuda K, Funahashi K, Hashimoto M, Maeda T, et al. Predictive factors for effective selection of Interleukin-6 inhibitor and tumor necrosis factor inhibitor in the treatment of rheumatoid arthritis. Sci Rep. 2020;10(1):16645.
23. 23. Choe JY, Bae J, Lee H, Bae SC, Kim SK. Relation of rheumatoid factor and anti-cyclic citrullinated peptide antibody with disease activity in rheumatoid arthritis: cross-sectional study. Rheumatol Int. 2013;33(9):2373-9.