The importance of red cell distribution width and neutrophil-lymphocyte ratio as a new biomarker in rheumatoid arthritis

Abstract

Objectives: Rheumatoid arthritis (RA) is a long-lasting autoimmune disorder that primarily affects the joints. Various biomarkers have been used for the prognosis and clinical follow-up. There are few studies that have investigated whether or not neutrophil-lymphocyte ratio (NLR) and red cell distribution width (RDW) are good indicators of systemic inflammation. The present study aims to explore the prognostic value of RDW and NLR in rheumatoid arthritis (RA) as a new inflammatory marker.

Methods: RA patients (n = 124) who presented to the Rheumatology outpatient clinic in our hospital between March 2015 and May 2015 were included in this study retrospectively. As a first group, 47 clinically active RA patients who had high acute phase proteins were included. In the second group, 73 clinically in-remission RA patients who had normal acute phase proteins were included. Fifty-five healthy volunteers constituted the control group.

Results: The mean RDW was found to be 15.2 ± 2.9 in the active group; 14.6 ± 2 in the inactive group and 13.4 ± 1.4 in the control group (p < 0.01). The mean NLR was found to be 3.7 ± 2.2 in the active group; 3.7 ± 1.6 in the inactive group and 3.2 ± 0.9 in the control group (p = 0.190). There were statistically significant differences between the RDW values of the active-period RA patients with the control group (p < 0.01). There was statistically significant difference between RDW values of active RA and inactive RA patients (p < 0.01). The NLR results between the RA group and the control group (p = 0.700); the active RA group, and the inactive RA group (p = 0.169) were similar. There was not statistically difference between the NLR values of active RA patients with the control group (p = 0.360). There was statistically difference between the NLR values of inactive RA patients with the control group (p = 0.047).

Conclusion: RDW was found higher in all RA group than control, additionally was also higher in active RA group than remission group. NLR values of remission group was higher than control. 

Keywords

• rheumatoid arthritis,biomarker,erythrocyte distribution width,neutrophil-lymphocyte ratio

References

1. [1] Majithia V, Geraci SA. Rheumatoid arthritis: diagnosis and management. Am J Med 2007;120:936-9.
2. [2] Nishimura K, Sugiyama D, Kogata Y, Tsuji G, Nakawaza T, Kawano S, et al. Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med 2007;146:797-808.
3. [3] Wang X. Neutrophil to lymphocyte ratio in relation to risk of all-cause mortality and cardiovascular events among patients undergoing angiography or cardiac revascularization: a meta-analysis of observational studies. Atherosclerosis 2014;234: 206-13.
4. [4] Wang J. The clinical significance of tumor-infiltrating neutrophils and neutrophil-to-CD8+ lymphocyte ratio in patients with resectable esophageal squamous cell carcinoma. J Transl Med 2014;12:7.
5. [5] Chimenti MS, Triggianese P, Conigliaro P, Candi E, Melino G, Perricone R.The interplay between inflammation and metabolism in rheumatoid arthritis. Cell Death Dis 2015;17:e1887.
6. [6] Giles JT. Cardiovascular disease in rheumatoid arthritis: Current perspectives on assessing and mitigating risk in clinical practice. Best Pract Res Clin Rheumatol 2015;29:597-613.
7. [7] Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red cell distribution width: a simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci 2015;52:86-105.
8. [8] Goodnow CC. Multistep pathogenesis of autoimmune disease. Cell 2007;130:25-35.

9. [9] Holzınger D, Föll D. [Biomarkers for chronic inflammatory diseases]. Z Rheumatol 2015;74:887-97. [Article in German]
10. [10] Sanmartí R, Gómez-Puerta JA. [Biomarkers in rheumatoid arthritis]. Rheumatol Clin 2011;6S3:S25-8. [Article in Spanish]
11. [11] Sertoglu E, Kayadibi H, Uyanık M. Is single red cell distribution width without iron, folic acid and vitamin B12 enough to decide? Hepatol Res 2014;44:1371.
12. [12] Peng YF, Zhang Q, Cao L, Liu Y, Chen D, Sun YK, et al. Red blood cell distribution width: a potential marker estimating disease activity of ankylosing spondylitis. Int J Clin Exp Med 2014;7:5289-95.
13. [13] Peristein TS, Weuve J, Pfeffer MA, Beckman JA. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med 2009;169:588-94.
14. [14] Harrington AM, Ward PC, Kroft SH.I ron defiency anemia, beta-thalassemia minor, and anemia of chronic disease: a morphologic reappraisal. Am J Clin Pathol 2008;29:466-71.
15. [15] Baynes RD, Bothwell TH, Bezwoda WR, Gear AJ, Atkinson P. Hematologic and iron-related measurements in rheumatoid arthritis. Am J Clin Pathol 1987;87:196-200.
16. [16] Hassan S, Antonelli M, Ballou S. Red cell distribution width: a measure of cardiovascular risk in rheumatoid arthritis patients. Clin Rheumatol 2015;34:1053-7.
17. [17] Vaya A, Hernandez JL, Calvo J, Mıco L, Romagrolı M, et al. RDW in patients with systemic lupus erythematosus influence of anemia and inflammatory markers. Clin Hemorrheol Microcirc 2013;54:333-9.
18. [18] Hu ZD, Chen Y, Zhang L, Sun Y, Huang YL, Wang QQ, et al. Red blood cell distribution width is a potential index to asses the disease activity of systemic lupus erythematosus. Clin Chim Acta 2013;425:202-05.
19. [19] Hu ZD, Sun Y, Guo J, Huang YL, Qin BD, Gao Q, et al. Red blood cell distribution width and neutrophil/lymphocyte ratio are positively correlated with disease activity in primary Sjögren's syndrome. Clin Biochem 2014;47:287-90.
20. [20] Farkos N, Szabo A, Larond V, Sarlos DP, Minier T, Prohaszka Z, et al. Clinical usefullness of measuring red blood cell distribution witdh in patients with systemic sclerosis. Rheumatology (Oxford) 2014;53:1439-45.
21. [21] Özer S, Yılmaz R, Sönmezgöz E, Karaaslan E, Taşkın S, Bütün İ, et al. Simple markers for subclinic inflammation in patients with familial mediterranean fever. Med Sci Monit 2005;21:298-303.
22. [22] Rodriguez-Carrio J, Alperi-Lopez M, Lopez P, Alonso-Castro S, Ballina-Garcia FJ, Suarez A. Red cell distribution width is associated with cardiovascular risk and disease parameters in rheumatoid arthritis. Rheumatology (Oxford) 2015;54:641-6.
23. [23] Mercan R, Bitik B, Tufan A, Bozbulut UB, Atas N, Ozturk MA, et al. The association between neutrophil/lymphocyte ratio and disease activity in rheumatoid arthritis and ankylosing spondylitis. J Clin Lab Anal 2016;30:597-601.
24. [24] Fu H, Qin B, Hu Z, Ma N, Yang M, Wei T, et al. Neutrophil- and platelet-to-lymphocyte ratios are correlated with disease activity in rheumatoid arthritis. Clin Lab 2015;61:269-73.
25. [25] Uslu AU, Küçük A, Şahin A, Ugan Y, Yılmaz R, Güngör T, et al. Two new inflammatory markers associated with disease activity score-28 in patients with rheumatoid arthritis: neutrophil-lymphocyte ratio and platelet-lymphocyte ratio. Int J Rheum Dis 2015;18:731-5.
26. [26] Tekeoğlu İ, Gürol G, Harman H, Karakeçe E, Çiftçi İH. Overlooked hematological markers of disease activity in rheumatoid arthritis. Int J Rheum Dis 2016;19:1078-82.
27. [27] Gökmen F, Akbal A, Reşorlu H, Gökmen E, Güven M, Aras AB, et al. Neutrophil-lymphocyte ratio connected to treatment options and inflammation markers of ankylosing spondylitis. J Clin Lab Anal. 2015;29:294-8.
28. [28] Uslu AU, Deveci K, Korkmaz S, Aydin B, Senel S, Sancakdar E, et al. Is neutrophil/lymphocyte ratio associated with subclinical inflammation and amyloidosis in patients with familial Mediterranean fever? Biomed Res Int 2013;2013:185317.
29. [29] Alan S, Tuna S, Türkoğlu EB. The relation of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume with the presence and severity of Behçet's syndrome. Kaohsiung J Med Sci 2015;31:626-31.
30. [30] Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H, et al. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol 2016;26:372-6.
31. [31] Kim DS, Shin D, Lee MS, Kim HJ, Kim DY, Kim SM, 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;43:305-10.
32. [32] Koca TT. Does obesity cause chronic inflammation? The association between complete blood parameters with body mass index and fasting glucose. Pak J Med Sci 2017;33:65-69.
33. [33] Yunchun L, Yue W, Jun FZ, Qizhu S, Liumei D. Clinical significance of red blood cell distribution width and inflammatory factors for the disease activity in rheumatoid arthritis. Clin Lab 2016;62:2327-31.
34. [34] He Y, Liu C, Zeng Z, Ye W, Lin J, Ou Q. Red blood cell distribution width: a potential laboratory parameter for monitoring inflammation in rheumatoid arthritis. Clin Rheumatol 2018;37:161-7.