Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio as Markers of Disease Activity in Rheumatoid Arthritis: Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Rheumatoid Arthritis

Hazrat Hussain; Muhammad Asghar; . Naila; . Musa; . Zeeshan; Alam Zeb

doi:10.54393/pjhs.v7i8.4216

Authors

Hazrat Hussain Department of Rheumatology, Medical Teaching Institute, Khyber Teaching Hospital, Peshawar, Pakistan
Muhammad Asghar Department of Rheumatology, Medical Teaching Institute, Khyber Teaching Hospital, Peshawar, Pakistan
. Naila Department of Rheumatology, Medical Teaching Institute, Khyber Teaching Hospital, Peshawar, Pakistan
. Musa Department of Rheumatology, Medical Teaching Institute, Khyber Teaching Hospital, Peshawar, Pakistan
. Zeeshan Department of Rheumatology, Medical Teaching Institute, Khyber Teaching Hospital, Peshawar, Pakistan
Alam Zeb Department of Rheumatology, Medical Teaching Institute, Khyber Teaching Hospital, Peshawar, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i8.4216

Keywords:

Rheumatoid Arthritis, C-Reactive Protein, Erythrocyte Sedimentation Rate, Neutrophil-to-Lymphocyte Ratio, Platelets-To-Lymphocytes Ratio, DAS28

Abstract

Rheumatoid arthritis (RA) is an inflammatory disease that adversely affects quality of life by impairing joint function. Objectives: To examine the use of NLR and PLR as activity indicators in RA. To ascertain their independent prediction by examining the relationships between these DAS28-ESR fractions of disease activity and other conventional inflammatory indicators like ESR and CRP. Methods: This study involved 230 rheumatoid arthritis patients assessed in the Department of Rheumatology, Khyber Teaching Hospital, Peshawar. Disease Activity Score 28 (DAS28) was used to assess disease activity together with clinical parameters, erythrocyte sedimentation rate, C-reactive protein, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and others. Multivariate regression and rank correlation (Spearman) were done to determine the relationship between these biomarkers and DAS28. Results: Significant positive correlations were identified between inflammatory markers and activity of the disease (DAS28), with NLR (ρ = 0.772, p<0.001) and PLR (ρ = 0.768, p<0.001) demonstrating notable connections. ESR (ρ = 0.912, p<0.001) and CRP (ρ = 0.917, p < 0.001) exhibited more robust relationships. In multivariable regression analysis, CRP (β = 0.454, p<0.001) and ESR (β = 0.423, p<0.001) were the strongest independent predictors of disease activity, while NLR remained a significant contributor (β = 0.116, p=0.001). ROC analysis showed good diagnostic performance for both NLR (AUC = 0.892) and PLR (AUC = 0.898), with PLR demonstrating slightly higher accuracy in identifying high disease activity. Conclusions: NLR and PLR are useful and cost-effective markers of disease activity in rheumatoid arthritis.

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