Relation of Disease Severity with Neutrophil Lymphocyte Ratio and Mean Platelet Volume in Rheumatoid Arthritis

Yıl 2019, Cilt: 14 Sayı: 3, 105 - 109, 15.11.2019

Gökhan Aytekin , İbrahim Akdağ

https://doi.org/10.17517/ksutfd.512962

Öz

Objective: Rheumatoid
arthritis (RA) is a systemic inflammatory disease characterized by symmetrical
erosive synovitis. The neutrophil to lymphocyte ratio (NLR) and mean platelet
volume (MPV) have been widely used to determine the severity of inflammation.
Objectives: We aimed to investigate NLR and MPV values in RA population further
assessing the relation between these indices, inflammatory markers and disease
activity scores.

Material and Methods: The present study
was performed between March 2012 and March 2013, and designed retrospectively.
Total 156 patients of RA were included.

 Results:
The NLR was higher in active disease group but there was not significant
difference between the remission group and active disease group (p: 0.616).
Also NLR of low disease activity group, moderate disease activity group and
high disease activity group were 1.98±0.71, 2.26±1.04, and 3.11±2.16
respectively. There is significant difference between groups (p: 0.030). The
MPV of remission group and active disease group were 8.54±0.78 fl and 8.89±0.99
fl, respectively and there is no significant difference between both groups (p:
0.126). Also the MPV of remission group, low disease activity group, moderate
disease activity group and high disease activity group were 9.31±1.09 fl,
8.91±0.98 fl, 8.71±0.97 fl, respectively. Although MPV is reduced in patients
with higher disease activity, it was found that there was no significant
difference between the groups (p: 0.206).

Conclusions: NLR can be a useful
marker to assess disease activity in RA patients. Increased NLR values ​​may
indicate increased disease activity. Whereas, there is a need for comprehensive
studies to claim that average platelet volume as an indicator of disease
severity in RA patients.

Anahtar Kelimeler

Neutrophil Lymphocyte Ratio, Mean Platelet Volume, Rheumatoid Arthritis

Romatoit Artritte Hastalık Aktivitesinin Nötrofil lenfosit Oranı ve Ortalama Trombosit Hacmi ile İlişkisi

Öz

Amaç: Romatoid Artrit
(RA), simetrik eroziv sinovit ile karakterize, kronik sistemik inflamatuvar bir
hastalıktır. Nötrofil lenfosit oranı (NLO) ve ortalama trombosit hacmi (OTH)
ise inflamasyonun şiddetini belirlemek için kullanılan yeni belirteçlerdir. Biz
bu çalışma ile RA'de hastalık aktivitesi ile NLO ve OTH değerleri arasındaki
ilişkiyi ortaya koymayı amaçladık.

Gereç ve Yöntemler: Bu retrospektif
çalışma Mart 2012 ile Mart 2013 arasında yapıldı. Çalışmaya toplam 156 RA
hastası dahil edildi.

Bulgular: NLO aktif hastalık
grubunda remisyon grubuna göre daha yüksekti, ancak remisyon grubu ile aktif
hastalık grubu arasında anlamlı fark yoktu (p: 0.616). Düşük hastalık
aktivitesi grubunda, orta derecede hastalık aktivitesi grubunda ve yüksek
hastalık aktivite grubunda NLO sırasıyla 1.98 ± 0.71, 2.26 ± 1.04 ve 3.11 ±
2.16 idi. Karşılaştırılan gruplar arasında istatiksel olarak anlamlı fark
mevcuttu (p: 0.030). Remisyon grubu ve aktif hastalık grubunun OTH değerleri
sırasıyla 8.54 ± 0.78 ve 8.89 ± 0.99 fl idi ve gruplar arasında anlamlı fark
yoktu (p: 0.126). Ayrıca remisyon grubu, düşük hastalık aktivite grubu, orta
hastalık aktivite grubu ve yüksek hastalık aktivite grubunda OTH sırasıyla 9.31
± 1.09, 8.91 ± 0.98, 8.71 ± 0.97 fl idi. Daha yüksek hastalık aktivitesi olan
hastalarda OTH azalmasına rağmen, gruplar arasında anlamlı fark mevcut değildi
(p: 0.206).

Sonuç: NLO, RA
hastalarında hastalık aktivitesini değerlendirmek için faydalı bir belirteçtir.
Artan NLO değerleri artmış hastalık aktivitesine işaret eder. Fakat OTH
değerlerinin RA hastalarında hastalık aktivite göstergesi olarak
kullanılabilmesi için daha kapsamlı çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Nötrofil lenfosit Oranı, Ortalama Trombosit Hacmi, Romatoit Artrit

Kaynakça

• 1. Kaushik P, Kaushik R. Diagnosis and management of rheumatoid arthritis. The American journal of medicine 2008;121:e7; author reply e9-10.
• 2. Wolfe F. Comparative usefulness of C-reactive protein and erythrocyte sedimentation rate in patients with rheumatoid arthritis. The Journal of rheumatology 1997;24:1477-85.
• 3. Beckham JC, Caldwell DS, Peterson BL et al. Disease severity in rheumatoid arthritis: relationships of plasma tumor necrosis factor-alpha, soluble interleukin 2-receptor, soluble CD4/CD8 ratio, neopterin, and fibrin D-dimer to traditional severity and functional measures. Journal of clinical immunology 1992;12:353-61.
• 4. Bhat T, Teli S, Rijal J et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert review of cardiovascular therapy 2013;11:55-9.5. Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Critical reviews in oncology/hematology 2013;88:218-30.
• 6. Ahsen A, Ulu MS, Yuksel S et al. As a new inflammatory marker for familial Mediterranean fever: neutrophil-to-lymphocyte ratio. Inflammation 2013;36:1357-62.
• 7. Khode V, Sindhur J, Kanbur D, Ruikar K, Nallulwar S. Mean platelet volume and other platelet volume indices in patients with stable coronary artery disease and acute myocardial infarction: A case control study. Journal of cardiovascular disease research 2012;3:272-5.
• 8. Kurt M, Onal IK, Sayilir AY et al. The role of mean platelet volume in the diagnosis of hepatocellular carcinoma in patients with chronic liver disease. Hepato-gastroenterology 2012;59:1580-2.
• 9. Yazici S, Yazici M, Erer B et al. The platelet indices in patients with rheumatoid arthritis: mean platelet volume reflects disease activity. Platelets 2010;21:122-5.10. Jurcut C, Jurcut R, Caraiola S et al. Platelet histogram indices and cardiovascular disease in patients with rheumatoid arthritis. Romanian journal of internal medicine = Revue roumaine de medecine interne 2010;48:51-5.
• 11. Prevoo ML, van 't Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis and rheumatism 1995;38:44-8.
• 12. Balsa A, Carmona L, Gonzalez-Alvaro I et al. Value of Disease Activity Score 28 (DAS28) and DAS28-3 compared to American College of Rheumatology-defined remission in rheumatoid arthritis. The Journal of rheumatology 2004;31:40-6.
• 13. Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. The American journal of cardiology 2008;102:653-7.
• 14. Ozturk ZA, Kuyumcu ME, Yesil Y et al. Is there a link between neutrophil-lymphocyte ratio and microvascular complications in geriatric diabetic patients? Journal of endocrinological investigation 2013;36:593-9.
• 15. Kuyumcu ME, Yesil Y, Ozturk ZA et al. The evaluation of neutrophil-lymphocyte ratio in Alzheimer's disease. Dementia and geriatric cognitive disorders 2012;34:69-74.
• 16. Mercan R, Bitik B, Tufan A et al. The Association Between Neutrophil/Lymphocyte Ratio and Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis. Journal of clinical laboratory analysis 2016;30:597-601.
• 17. Yang W, Wang X, Zhang W et al. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are 2 new inflammatory markers associated with pulmonary involvement and disease activity in patients with dermatomyositis. Clinica chimica acta; international journal of clinical chemistry 2017;465:11-16.
• 18. Kucuk A, Uslu AU, Ugan Y et al. Neutrophil-to-lymphocyte ratio is involved in the severity of ankylosing spondylitis. Bratislavske lekarske listy 2015;116:722-5.
• 19. Qin B, Ma N, Tang Q et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Modern rheumatology 2016;26:372-6.
• 20. Uslu AU, Kucuk A, Sahin A et al. Two new inflammatory markers associated with Disease Activity Score-28 in patients with rheumatoid arthritis: neutrophil-lymphocyte ratio and platelet-lymphocyte ratio. International journal of rheumatic diseases 2015;18:731-5.
• 21. Fu H, Qin B, Hu Z et al. Neutrophil- and platelet-to-lymphocyte ratios are correlated with disease activity in rheumatoid arthritis. Clinical laboratory 2015;61:269-73.
• 22. Chandrashekara S, Mukhtar Ahmad M, Renuka P, Anupama KR, Renuka K. Characterization of neutrophil-to-lymphocyte ratio as a measure of inflammation in rheumatoid arthritis. International journal of rheumatic diseases 2017;20:1457-1467.
• 23. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Current pharmaceutical design 2011;17:47-58.
• 24. Talukdar M, Barui G, Adhikari A, Karmakar R, Ghosh UC, Das TK. A Study on Association between Common Haematological Parameters and Disease Activity in Rheumatoid Arthritis. Journal of clinical and diagnostic research : JCDR 2017;11:Ec01-ec04.
• 25. Kisacik B, Tufan A, Kalyoncu U et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint, bone, spine : revue du rhumatisme 2008;75:291-4.