Romatoid artritte nütrisyonel–inflamatuvar indeksler ile hastalık aktivitesi arasındaki ilişkide yaşa bağlı farklılıklar

Abstract

Amaç: Romatoid artrit (RA), inflamasyon ve beslenme durumunun birlikte hastalık şiddeti ve prognozu üzerinde etkili olduğu kronik inflamatuvar bir hastalıktır. Bu çalışmada RA’lı hastalarda nutrisyonel–inflamatuvar indeksler olan C-reactive protein–Albumin–Lymphocyte (CALLY), Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT) ve Geriatric Nutritional Risk Index (GNRI) skorlarının hastalık aktivitesiyle ilişkilerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Ocak 2024–Temmuz 2025 tarihleri arasında Romatoloji Polikliniği’ne başvuran 199 RA hastasının klinik ve laboratuvar verileri retrospektif olarak incelendi. Hastalık aktivitesi DAS28-CRP, CDAI ve SDAI skorlarıyla değerlendirildi. PNI, CONUT, CALLY ve ≥60 yaş için GNRI değerleri hesaplanarak hastalık aktivitesi ve nutrisyonel parametrelerle korelasyonları analiz edildi. Bulgular: Çalışmaya dahil edilen 199 hastanın yaş ortalaması 53,4 ± 14,5 yıl olup, %72,9’u kadındı. CALLY ve PNI indeksleri, DAS28-CRP ve SDAI dahil olmak üzere hastalık aktivitesi göstergeleriyle güçlü negatif korelasyonlar gösterdi. CONUT skorunun hastalık aktivitesiyle anlamlı bir ilişkisi bulunmadı. Geriatrik grupta (≥60 yaş) tüm indeksler ile hastalık aktivitesi arasındaki korelasyonlar daha güçlü olup, GNRI’nin hem malnütrisyon riski hem de inflamatuvar aktiviteyle negatif ilişkili olduğu saptandı. Sonuç: CALLY ve PNI, RA’da inflamatuvar yük ve beslenme durumunu bütüncül biçimde yansıtan güvenilir ve pratik laboratuvar belirteçleridir. GNRI, özellikle ileri yaş hastalarda malnütrisyon ve inflamasyona bağlı kırılganlığı değerlendirmede klinik açıdan yararlıdır. Nutrisyonel–inflamatuvar indekslerin rutin klinik değerlendirmelere entegrasyonu, hastalık aktivitesinin daha kapsamlı izlenmesine ve bütüncül hasta yönetimine katkı sağlayabilir.

Keywords

• CRP-albümin-lenfosit (CALLY)
• romatoid artrit
• hastalık aktivitesi
• geriatrik nutrisyonel risk indeksi (GNRI)

Age-related differences in the association between nutritional– inflammatory indices and disease activity in rheumatoid arthritis

Abstract

Objective: Rheumatoid arthritis (RA) is a chronic inflammatory disease in which inflammation and nutritional status jointly influence disease severity and prognosis. This study aimed to evaluate the relationships between nutritional–inflammatory indices—C-reactive protein–Albumin–Lymphocyte (CALLY) index, Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT) score, and Geriatric Nutritional Risk Index (GNRI)—and disease activity in patients with RA. Materials and Methods: Clinical and laboratory data of 199 RA patients who presented to the Rheumatology Outpatient Clinic between January 2024 and July 2025 were retrospectively analyzed. Disease activity was assessed using DAS28-CRP, CDAI, and SDAI scores. PNI, CONUT, CALLY, and GNRI values (for patients aged ≥60 years) were calculated, and their correlations with disease activity and nutritional parameters were examined. Results: The study included 199 patients with a mean age of 53.4 ± 14.5 years, of whom 72.9% were female. The CALLY and PNI indices showed strong negative correlations with disease activity indicators, including DAS28-CRP and SDAI scores. The CONUT score was not significantly associated with disease activity. In the geriatric subgroup (≥60 years), correlations between all indices and disease activity were stronger, and GNRI was found to be negatively associated with both malnutrition risk and inflammatory activity. Conclusion: The CALLY and PNI indices are reliable and practical laboratory markers that comprehensively reflect inflammatory burden and nutritional status in RA. GNRI appears clinically useful for assessing malnutrition and inflammation-related frailty, particularly in older patients. Integrating nutritional–inflammatory indices into routine clinical evaluation may enhance comprehensive monitoring of disease activity and support comprehensive patient management.

Keywords

• CRP-albumin-lymphocyte (CALLY)
• rheumatoid arthritis
• disease activity
• geriatric nutritional risk index (GNRI)

References

1. Di Matteo A, Bathon JM, Emery P. Rheumatoid arthritis. Lancet. 2023; 402: 2019–33.
2. Fraenkel L, Bathon JM, England BR, St Clair EW, Arayssi T, Carandang K, et al. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2021; 73: 924–39.
3. Janke K, Kiefer C, McGauran N, Richter B, Krause D, Wieseler B. A systematic comparison of different composite measures (DAS 28, CDAI, SDAI, and Boolean approach) for determining treatment effects on low disease activity and remission in rheumatoid arthritis. BMC Rheumatol. 2022; 6: 82.
4. Tian P, Xiong J, Wu W, Li X, Liu L, Zhang W, et al. Impact of the malnutrition on mortality in Rheumatoid arthritis patients: A cohort study from NHANES 1999–2014. Front Nutr. 2023; 9: 993061.
5. Nikiphorou E, Philippou E. Nutrition and its role in prevention and management of rheumatoid arthritis. Autoimmun Rev. 2023; 22: 103333.
6. Kılıç Ö, Tecer D, Canbaş M, Kaya MN, Çınar M, Yılmaz S. Immune nutrition indices are associated with disease activity in rheumatoid arthritis: a cross-sectional study. Biomark Med. 2024; 18: 1093–102.
7. Öz N, Gezer HH, Cilli Hayıroğlu S, Duruöz MT. Evaluation of the prognostic nutritional index (PNI) as a tool for assessing disease activity in rheumatoid arthritis patients. Clin Rheumatol. 2024; 43: 1461–7.
8. Zhang J, Lin Y, Zeng J, Li Y, Xu H, Wang C, et al. The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index exhibits an L-shaped association with all-cause mortality in rheumatoid arthritis patients: a retrospective cohort study. BMC Rheumatol. 2025; 9: 47.

9. Cano-García L, Redondo-Rodríguez R, Manrique-Arija S, Navarro-Millán I, Martínez-López JA, González-Duarte A, et al. Prevalence of malnutrition and associated factors in older patients with rheumatoid arthritis: A cross-sectional study. Nutrients. 2023; 15: 3500.
10. Wells G, Becker JC, Teng J, Dougados M, Schiff M, Smolen J, et al. Validation of the 28-joint Disease Activity Score (DAS28) and European League Against Rheumatism response criteria based on C-reactive protein against disease progression in patients with rheumatoid arthritis, and comparison with the DAS28 based on erythrocyte sedimentation rate. Ann Rheum Dis. 2009; 68: 954–60.
11. Aletaha D, Nell VP, Stamm T, Uffmann M, Pflugbeil S, Machold K, et al. Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score. Arthritis Res Ther. 2005; 7: R796–806.
12. Salinas M, Flores E, Blasco A, López-Garrigós M, Puche C, Asencio A, et al. CONUT: a tool to assess nutritional status. First application in a primary care population. Diagnosis (Berl). 2020; 8: 373–6.
13. Tsai YT, Ko CA, Chen HC, Ho CM, Yang T, Lin YM, et al. Prognostic value of CRP-albumin-lymphocyte (CALLY) index in patients undergoing surgery for oral cavity cancer. J Cancer. 2022; 13: 3000–12.
14. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005; 82: 777–83.
15. Pavlov-Dolijanovic S, Bogojevic M, Nozica-Radulovic T, Radunovic G, Mujovic N. Elderly-Onset Rheumatoid Arthritis: Characteristics and Treatment Options. Medicina (Kaunas). 2023; 59: 1878.
16. Franceschi C, Garagnani P, Parini P, Giuliani C, Santoro A. Inflammaging: a new immune-metabolic viewpoint for age-related diseases. Nat Rev Endocrinol. 2018; 14: 576–90.
17. Soysal P, Stubbs B, Lucato P, Luchini C, Solmi M, Peluso R, et al. Inflammation and frailty in the elderly: A systematic review and meta-analysis. Ageing Res Rev. 2016; 31: 1–8.