AB0800\u2005HEMATOLOGICAL MARKERS OF SYSTEMIC INFLAMMATION IN PATIENTS RHEUMATOID ARTHRITIS (RA) AND SPONDYLOARTHRITIS (SPA)

Abstract

An appropriate assessment of disease activity is essential in the management of patients with chronic inflammatory joint diseases, rheumatoid arthritis (RA) and spondyloarthritis (SpA). Hematological parameters [Neutrophil-To-Lymphocyte (NLR), Platelet-To-Lymphocyte (PLR) and Monocyte-To- Lymphocyte (MLR) ratios] have been demonstrated to be good, promising indicators of systemic inflammation status in different diseases, additionally to conventional inflammatory markers [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)]. However results remain conflicting in rheumatic patients.The goal of the study was to determine the role of NLR, PLR, MLR in assessing inflammatory disease activity and to compare the biomarkers in RA and SpA patients.An observational study was conducted in patients with RA and SpA (ankylosing spondylitis and psoriatic arthritis) treated in the Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Poland. Demographic and clinical information was obtained through structured interview, review of medical records and laboratory tests. The following disease activity and functional scores were registered: CRP and ESR levels, swollen and tender joints counts (SJC, TJC), DAS28 (ESR), HAQ, BASDAI, BASFI, patient global assessment (PtGA) and physician global assessment (PGA) rated on a visual analogue scale (VAS).The study group consisted of 95 patients (58 women, 37 men), with the mean (SD) age 45.4 (9.9), disease duration 10.0 (8.4) years. There were 58 (61.1%) patients with RA (44 women, 14 men) and 37 (38.9%) patients with SpA. The mean age and disease duration were statistically not different in both patients’ groups. The mean (SD) DAS28 was 4.21 (1.8) in RA patients; in SpA patients BASDAI 4.9 (2.6) and BASFI 5.0 (2.8).In the whole group (95 patients) and in the SpA group, we found positive correlations between the PLR value and the following parameters CRP, ESR; between NLR and CRP, ESR; between MLR and CRP. In the RA group positive correlations were observed between PLR and CRP, ESR; NLR and CRP; MLR did not correlate with CRP and ESR.In RA patients, there were statistically significant correlations between values of PLR and DAS28 (r=0.356, p=0.006), TJC (r=0.308, p=0.02), SJC (r=0.318, p=0.016), PtGA (r=0.372, p=0.008). No significant correlation was found between NLR, MLR and other disease activity scores.In SpA patients, we found a significant correlation between NLR and PtGA (r=0.488, p=0.04). No significant correlations were found between NLR, PLR, MLR and BASDAI, BASFI.The group of RA patients as compared with SpA, was characterized by significantly higher value of PLR [respectively 207.8 (94.0) vs 169.9 (77.7), p=0.04]. In turn, SpA patients compared with RA, were characterized by unfavorable metabolic parameters: higher atherogenic index [respectively 4.03 (0.8) vs 3.57 (1.1), p=0.03], lower HDL-cholesterol [47.4 (10.7) vs 56.1 (16.4) mg/dl (p=0.006); higher serum uric acid [5.6 (1.2) vs 4.5 (1.4) mg/dl (p=0.0001)], higher waist measurement [96.1 (14.2) vs 85.9 (11.5) cm (p=0.0003).In our study we found, that in patients with RA, PLR was associated with both clinical and inflammatory markers of disease activity; in SpA patients NLR, PLR and MLR were associated with conventional inflammatory markers (CRP, ESR). Hematological inflammatory biomarkers may reflect disease activity and could represent potential parameters to evaluate disease activity not only in RA, but also in SpA.Bozena Targonska-Stepniak Speakers bureau: Berlin-Chemie/Menarini, KRKA, Medac, Santen, Krzysztof Grzechnik: None declared, Maria Majdan Speakers bureau: Roche, Medac