Usability of Hematologic Parameters in Primary Care to Show Disease Activity in Patients with Ankylosing Spondylitis

Abstract

Introduction: Ankylosing spondylitis (AS) is a type of chronic inflammatory arthritis resulting in ankylosis of the spine and inflammation of the tendons. In this study, we aimed to investigate the usability of hematologic parameters to determine disease activity in AS patients. Materials and Methods: A total of 65 patients who were previously diagnosed with AS were enrolled retrospectively in the current study. Patients were divided into two groups according to their Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores. Thirty-one patients who had BASDAI score > 5 served as “active AS” and 34 patients who had BASDAI score < 5 served as “inactive AS”. Patients data including their physical examination findings were recorded. Medications, demographic properties, and laboratory findings of the patients were also recorded. Results: The clinical and demographic features of both groups were comparable. There were no differences between groups according to the use of medications, the duration of AS and the presence of uveitis, enthesopathy, and peripheral arthritis. In laboratory findings, the Erythrocyte Sedimentation Rate (ESR), C-reactive Protein (CRP) and Neutrophil/Lymphocyte Ratio (NLR) were significantly higher, Mean Platelet Volume (MPV) was significantly lower in active AS group than in inactive AS group. In the correlation analysis, BASDAI score had a significantly negative correlation with MPV (r=-0.309, p=0.012) and significantly positive correlations with ESR, CRP and N/L values (r=0.427, p<0.001, r=0.328, p=0.008 and r=0.316, p=0.010, respectively). In linear regression analysis , only MPV score was found to be a predictor for AS activity (p<0.04).Conclusion: Mean platelet volume is significantly negative correlated with BASDAI score and could provide a clue for primary care physician which patients who are at high risk for AS activity. Giriş: Ankilozan spondilit (AS) omurgada ankiloza yol açan ve tendonlarda inflamasyon oluşturan kronik inflamatuvar artrit çeşididir. Bu çalışmada, AS hastalarında hastalık aktivitesini göstermede hematolojik parametrelerin kullanılabilirliğini araştırdık. Gereç ve Yöntem: Çalışmaya daha önce AS tanısıyla takip edilen toplam 65 hasta retrospektif olarak dahil edildi. Hastalık aktivitesini gösteren Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) skoruna göre hastalar iki gruba ayrıldı. BASDAI skoru> 5 olan toplam 31 hasta aktif AS ve BASDAI skoru < 5 olan toplam 34 hasta inaktif AS olarak ayrıldı. Detaylı fizik muayene bulguları da olmak üzere tüm hastaların verileri kaydedildi. Ayrıca hastaların ilaç kullanımları, demografik ve laboratuvar verileri kaydedildi. Bulgular: Her iki grup klinik ve demografik özellikler açısından benzerdi. Ayrıca ilaç kullanım öyküsü, hastalık yaşı, üveit varlığı, entesopati varlığı ve periferik artrit varlığı açısından da iki grup arasında istatiksel fark saptanmadı. Aktif AS grubunda Eritrosit Sedimentasyon Hızı (ESH), C-reaktif Protein (CRP) ve Nötrofil/Lenfosit oranı (NLR) inaktif AS grubuna göre belirgin olarak yüksek, Ortalama Platelet Hacmi (OPH) ise belirgin olarak düşük saptandı. Korelasyon analizinde BASDAI skoru OPH ile belirgin negatif (r=-0,309, p=0,012), ESH, CRP ve NLR ile belirgin pozitif korelasyona sahipti (sırasıyla, r=0,427, p<0,001, r=0,328, p=0,008 ve r=0,316, p=0,010). Bu değişkenler lineer regresyon analizine sokulduğunda sadece OPH’ nin AS hastalık aktivitesini predikte ettiği saptandı (p<0,04). Sonuç: OPH hastalık aktivitesini gösteren BASDAI skoru ile belirgin şekilde negatif ilişkilidir ve birinci basamak aile hekimleri için hangi hastaların AS aktivitesi için yüksek riskli olduğuna dair bir ipucu sağlayabilir.

Keywords

• Ankylosing spondylitis,BASDAI score,neutrophyl/lymphocyte ratio,mean platelet volume,primary care

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