Romatoid Artritte Yeni Bir İnflamasyon Belirteci: İmmatür Granülosit

Öz

Amaç: Bu çalışmanın amacı immatür granülosit sayısının, romatoid artritte hastalık ativitesini gösteren bir belirteç olup olmadığını ortaya koymaktır. Gereç ve Yöntemler: Çalışmaya, Kastamonu Rehabilitasyon Merkezi'nde romatoid artrit tanısı ile takipli 163 hasta alındı. Hastaların verileri, laboratuar bilgi sisteminden bulundu. Kontrol grubu için 92 sağlıklı bireyin laboratuvar verileri kullanıldı. Aktif enfeksiyonu, hematolojik, kardiyovasküler, metabolik ve malign hastalığı olan hastalar ile son 15 gün içinde travma, cerrahi girşim ve hastaneye yatış öyküsü olanlar çalışma dışı bırakıldı. Bulgular: Hasta grubunda immatür granülosit sayısı ve yüzdesinin anlamlı olarak daha yüksek olduğunu bulundu (p<0.05). Hasta grubunda immatür granülosit ile eritrosit sedimentasyon hızı (r=0.171 p=0.03), ve C-reaktif protein (r=0.321 p<0.001) arasında pozitif ilişki saptandı. Yine hasta grubunda grubunda, immatür granülosit sayısı ve yüzdesi, C-reaktif protein düzeyi >5 olan hastalarda, C-reaktif protein düzeyi <5 olanlara göre istatistiksel olarak anlamlı derecede yüksekti (p<0.05). Sonuç: İmmatür granülosit seviyesi, romatoid artritte inflamasyonu gösteren hızlı, kolay erişilebilir ve uygun maliyetli bir belirteç olabilir.

Anahtar Kelimeler

• Romatoid artrit
• immatür granülosit
• hastalık aktivitesi

A NEW INFLAMMATION MARKER IN RHEUMATOID ARTHRITIS: IMMATURE GRANULOCYTE

Öz

Objective: This study aimed to reveal whether immature granulocyte levels can be used for determining the disease activity of rheumatoid arthritis. Material and Methods: The study was conducted in the Kastamonu Rehabilitation Center. The data of 163 patients with rheumatoid arthritis were reviewed retrospectively. Laboratory data of 92 healthy individuals were used for the control group. Complete blood cell counts, measurement of erythrocyte sedimentation rate, and C-reactive protein level were used for the laboratory assessments. The individuals with active infection and any hematological, cardiovascular, metabolic disorder, malignancy, history of trauma, surgery, and hospitalization within the last 15 days were excluded from the study. Results: We found that the number and percentage of immature granulocyte were significantly higher in the patient group (p<0.05). A positive correlation was found between immature granulocyte and erythrocyte sedimentation rate (r=0.171 p=0.03), immature granulocyte and C-reactive protein (r=0.321 p<0.001) in the patient group. In the rheumatoid arthritis group, the number and percentage of immature granulocytes were statistically significantly higher in patients with C-reactive protein >5 than those with C-reactive protein ≤ 5 (p<0.05). Conclusion: The immature granulocytes can be a rapid, easily accessible and cost-effective parameter that indicates inflammation in rheumatoid arthritis. It may be useful to use this parameter in the evaluation of disease activity.

Anahtar Kelimeler

• Rheumatoid arthritis
• immature granulocyte
• disease activity

Kaynakça

1. Lwin MN, Serhal L, Holroyd C, Edwards C, Therapy. Rheumatoid arthritis: the impact of mental health on disease: a narrative review. Rheumatol Ther. 2020;7(3):457-71.
2. .Buzatu C, Moots R. Measuring disease activity and response to treatment in rheumatoid arthritis. Expert Rev Clin Immunol. 2019;15(2):135-45.
3. Wolfe F, Cathey M. The assessment and prediction of functional disability in rheumatoid arthritis. J Rheumatol.1991;18(9):1298-306.
4. Lv F, Song LJ, Li X. Combined measurement of multiple acute phase reactants to predict relapse of rheumatoid arthritis. Int J Rheum Dis. 2015;18(7):725-30.
5. Singh JA, Saag KG, Bridges Jr SL, Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. 2016;68(1):1-26.
6. Jain S, Gautam V, Naseem S, Sciences B. Acute-phase proteins: As diagnostic tool. J Pharm Bioallied Sci. 2011;3(1):118-27.
7. Peng Y-F, Cao L, Zeng Y-H, Zhang Z-X, Chen D, Zhang Q, et al. Platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in patients with rheumatoid arthritis. Open Med (Wars). 2015;10(1):249-53.
8. Tekeoğlu İ, Gürol G, Harman H, Karakeçe E, Çiftçi İ. Overlooked hematological markers of disease activity in rheumatoid arthritis. Int J Rheum Dis. 2016;19(11):1078-82.

9. Incir S, Calti HK, Palaoglu K. The role of immature granulocytes and inflammatory hemogram indices in the inflammation. Int J Med Biochem 2020;3(3):125-30.
10. Çiğri E, Gülten S, Yildiz E. The use of immature granulocyte and other complete blood count parameters in the diagnosis of transient tachypnea of the newborn. Ann Med Surg (Lond). 2021;72,102960.
11. Karakulak S, Narcı H, Ayrık C, Erdoğan S, Üçbilek E. The prognostic value of immature granulocyte in patients with acute pancreatitis. Am J Emerg Med. 2021;44:203-7.
12. Ünal Y. A new and early marker in the diagnosis of acute complicated appendicitis: immature granulocytes. Ulus Travma Acil Cerrahi Derg. 2018;24(5):434-9.
13. Shrivastava AK, Pandey AJJop, biochemistry. Inflammation and rheumatoid arthritis. J Physiol Biochem. 201;69(2):335-47.
14. Kay J, Upchurch KS. ACR/EULAR 2010 rheumatoid arthritis classification criteria. Rheumatology (Oxford). 2012 Dec;51 Suppl 6:vi5-9. doi: 10.1093/rheumatology/kes279.
15. Al-Ansari A, Hussein I. AB0150 Immature granulocytes level is a potential biomarker in peripheral enthesitis. In: BMJ Publishing Group Ltd; Ann Rheum Dis: 2019; 1533.
16. 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(7):731-5.
17. Farr M, Scott D, Constable T, Hawker R, Hawkins C, Stuart JJAotrd. Thrombocytosis of active rheumatoid disease. Ann Rheum Dis. 1983;42(5):545-9.
18. Cylwik B, Chrostek L, Gindzienska-Sieskiewicz E, Sierakowski S, Szmitkowski MJAims. Relationship between serum acute-phase proteins and high disease activity in patients with rheumatoid arthritis. Adv Med Sci. 2010;55(1):80-5.
19. Wolfe F. Comparative usefulness of C-reactive protein and erythrocyte sedimentation rate in patients with rheumatoid arthritis. J Rheumatol. 1997;24(8):1477-85.
20. Van Riel P, Renskers LJCER. The Disease Activity Score (DAS) and the Disease Activity Score using 28 joint counts (DAS28) in the management of rheumatoid arthritis. Clin Exp Rheumatol. 2016;34(5 Suppl 101):S40-S44.
21. Nierhaus A, Klatte S, Linssen J, Eismann NM, Wichmann D, Hedke J, et al. Revisiting the white blood cell count: immature granulocytes count as a diagnostic marker to discriminate between SIRS and sepsis-a prospective, observational study. BMC Immunol. 2013;14:1-8.
22. Ünal Y, Barlas AM, Surgery E. Role of increased immature granulocyte percentage in the early prediction of acute necrotizing pancreatitis. Ulus Travma Acil Cerrahi Derg. 2019;25(2):177-82.
23. Pincus T, Sokka T. Laboratory tests to assess patients with rheumatoid arthritis: advantages and limitations. Rheum Dis Clin North Am. 2009;35(4):731-4.
24. Ward M. Relative sensitivity to change of the erythrocyte sedimentation rate and serum C-reactive protein concentration in rheumatoid arthritis. J Rheumatol. 2004;31(5):884-95
25. Roodenrijs NM, Welsing PM, van der Goes MC, Tekstra J, Lafeber FP, Jacobs JW, et al. Healthcare utilization and economic burden of difficult-to-treat rheumatoid arthritis: a cost-of-illness study. Rheumatology (Oxford). 2021;60(10):4681-90.
26. Wright HL, Makki FA, Moots RJ, Edwards SWJJolb. Low‐density granulocytes: functionally distinct, immature neutrophils in rheumatoid arthritis with altered properties and defective TNF signaling. J Leukoc Biol. 2017;101(2):599-611.
27. Weinhage T, Kölsche T, Rieger-Fackeldey E, Schmitz R, Antoni A-C, Ahlmann M, et al. Cord Blood Low-Density Granulocytes Correspond to an Immature Granulocytic Subset with Low Expression of S100A12. J Immunol. 2020;205(1):56-66.