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Characterization of neutrophil‐to‐lymphocyte ratio as a measure of inflammation in rheumatoid arthritis
Author(s) -
Chandrashekara S.,
Mukhtar Ahmad Masoodi,
Renuka Panchagnula,
Anupama K. R.,
Renuka K.
Publication year - 2017
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.13157
Subject(s) - medicine , erythrocyte sedimentation rate , rheumatoid arthritis , neutrophil to lymphocyte ratio , gastroenterology , c reactive protein , arthritis , lymphocyte , inflammation , immunology
Objectives The neutrophil to lymphocyte ratio ( NLR ) is one of the well‐recognized sensitive measures of inflammation. This cross‐sectional observational study was aimed at characterizing the relationship of NLR with the inflammatory markers erythrocyte sedimentation rate ( ESR ), C‐reative protein ( CRP ), Disease Activity Score of 28 joints ( DAS 28)‐ CRP (3), joint counts and quality measures of rheumatoid arthritis ( RA ). Materials and Methods Patients with RA were recruited in two phases. The following were assessed for all patients: joint count, pain by visual analogue scale ( VAS ), complete blood count, ESR , CRP and quality index assessment using the Short Form health survey ( SF ‐36) questionnaire. A subgroup analysis was also performed to evaluate the association between NLR and cytokines. Results Four hundred and eighty‐nine subjects were recruited. Distribution of NLR values corresponded with DAS 28‐ CRP (3) rather than CRP and ESR . A significant difference in VAS , swollen joint counts ( SJC ‐28), inflammatory parameters and general health outcome measures was observed among the NLR groups. A weak correlation was observed between NLR and RA disease measures. It had least bias at lower ranges with DAS 28‐ CRP (3) than CRP and ESR . The NLR cut‐off value of 1.4 classified the patients in deep remission with 90% specificity, 24% sensitivity, likelihood ratio positive ( LR +) 2.46 and likelihood ratio negative (LR−) 0.84. CRP was a significant baseline predictor of NLR . A significant influence of interleukin‐6 on CRP was noted. Conclusion In contrast to the traditional markers, NLR may serve as a less expensive and effective measure of inflammation in RA . Its efficacy is comparable to that of CRP and it is not impacted by the cytokines influencing CRP and ESR .