Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Rheumatoid Arthritis
Condition: Rheumatoid Arthritis
MeSH terms: Arthritis; Arthritis, Rheumatoid
Study type: Observational

Summary: 
      Rheumatoid arthritis is an autoimmune disease characterized by synovial inflammation and
      joint destruction that follows a relapsing- remitting course.Disease activity assessment is
      important for rheumatoid arthritis management .Neutrophil lymphocyte ratio and platelet
      lymphocyte ratio are associated with inflammatory status and can be used to assess disease
      activity in rheumatoid arthritis
    

Detailed description: 
      Rheumatoid arthritis is an autoimmune disease characterized by synovial inflammation and
      joint destruction that follows a relapsing - remitting course and induce severe disability .
      Rheumatoid arthritis is an inflammatory disease that causes devastating joint destruction if
      patients are not appropriately treated. It is characterized by symmetric joint involvement,
      erosion and deformity in the joints as a result of synovial inflammation .Inflammation is the
      key determinant and primary underlying mechanism leading to disability and increased
      mortality in patients with rheumatoid arthritis.Disease activity assessment is important for
      rheumatoid arthritis management, since it could greatly affect the clinical decision. Current
      disease activity assessment mainly depend on clinical symptoms, signs and laboratory tests.
      laboratory Investigations are much preferred due to the advantage of less observer
      variations.

      Therefore assessment of inflammation in rheumatoid arthritis with reliable markers is crucial
      to predict long term outcome of a particular patient. The most commonly used markers for this
      purpose are ESR and CRP in daily practice. However both of these markers have some
      limitations such as reflection of short-term inflammatory activity and low discrimination
      ability with other superimposed conditions.

      Systemic inflammation is associated with changes in circulating blood cells quantity and
      composition. Normochromic anemia, thrombocytosis, neutrophilia and lymphopenia usually occur
      with many inflammatory conditions so the features of circulating blood cell components can be
      used for the assessment of inflammatory activity .

      Parameters of hemogram, particularly those including immune system elements are important in
      the assessment of different diseases and or sign. Immune system elements involve the
      neutrophils, lymphocytes and platelets that have a role in the control of inflammation, while
      also undergoing changes secondary to inflammation. Patients with rheumatoid arthritis may be
      found with increasing platelet counts during active stages of the disease. The counts
      decrease up on remission of inflammation but detailed role played by platelets remains
      unobvious .

      Platelet count, mean platelet volume (MPV), platelet distribution width (PDW) are three
      useful indices of platelet function reflecting the platelet production rate. .

      Gokmen et al 2016 concluded that MPV and neutrophil lymphocyte ratio (NLR) together with
      acute phase reactant C.reactive Protein(CRP), erythrocyte sedimentation rate (ESR) can be a
      useful indices for showing inflammation in RA patients and demonstrated that MPV negatively
      correlated with CRP and NLR positively correlated with ESR, CRP and anti cyclic citrullinated
      peptide antibody (antiCCP). The author concluded that high NLR levels in patients with RA is
      important in predicting prognosis of disease and development of more joint damage and
      hypothesized that NLR may be Considered to be an indicator of inflammation, disease activity
      and disease prognosis.

      Previous studies have shown that increased neutrophil to lymphocyte ratio (NLR) and platelet
      to lymphocyte ratio (PLR) are associated with poor prognosis of various inflammatory related
      diseases such as cancer, chronic kidney disease , acute pancreatitis ) and myocardial
      infarction . This may be due to the fact that both PLR and NLR are associated with the
      inflammatory status .

      Based on these Studies recently Fu el at., in 2015 hypothesized that both NLR and PLR
      correlated with the disease activity of RA and suggested that NLR and PLR may be indices for
      assessment of RA disease activity.

      Uslu et al 2015 demonstrated that NLR and PLR were elevated in rheumatoid arthritis patients
      with active disease compared with patients in remission. So they concluded that NLR and PLR
      were two new inflammatory markers which could be used to assess disease activity in patients
      with rheumatoid arthritis
    

Intervention name(s): Disease Activity Score-28
Intervention type(s): Other
Intervention description(s): Assessment of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio and their association with Disease Activity Score-28
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        One hundred rheumatoid arthritis patients divided into two groups. The first group with
        active disease and the second group with disease remission. There are 50 healthy
        participants age and sex matched as control group.