AB1314 ROLE OF NEUTROPHIL TO LYMPHOCYTE RATIO, MONOCYTE TO LYMPHOCYTE RATIO, PLATELET TO LYMPHOCYTE RATIO, EOSINOPHIL TO LYMPHOCYTE AND BASOPHILE TO LYMPHOCYTE RATIO IN ASSESSING DISEASE ACTIVITY IN SPONDYLOARTHRITIS
Authors: Salomé Garcia, Bruno Miguel Fernandes, Sara Ganhão, Raquel Ferreira, Miguel Bernardes, Georgina Terroso, Lúcia Costa
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), eosinophil to lymphocyte ratio (ELR) and basophile to lymphocyte ratio (BLR) have been demonstrated to be promising systemic inflammation markers. NLR, MLR and PLR have been associated with disease activity in Spondyloarthritis (SpA) but the results remain conflicting. <h3>Objectives</h3> We aim to determine the role of NLR, MLR, PLR, ELR and BLR in assessing disease activity in SpA. <h3>Methods</h3> Observational retrospective study was performed including consecutive patients with the diagnosis of SpA (according to ASAS classification criteria) followed at our Rheumatology Department. Demographic, clinical (including BASDAI, BASFI, ASDAS ESR and ASDAS CRP indices) and laboratorial data were collected from our national database at baseline and 6 months after initiation of a tumour necrosis factor inhibitor (TNFi). Correlations between variables were studied using Spearman correlation analysis and comparison between groups was performed using Wilcoxon test. <h3>Results</h3> The mean age of patients (n=297) was 41 years old (± 12), 160 (53.9%) were males with median disease duration of 12.4 (IQR 14.8) years. Two hundred and seven patients (69.7%) had Ankylosing Spondylitis, 26 (8.8%) Inflammatory Bowel Disease related SPA and 36 (12.1%) Undifferentiated SpA. Seventy-three (24.7%) patients were taking glucocorticoids and regarding conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) use before starting the TNFi: 188 (63.3%) were not under any csDMARD and the remaining ones were under Sulfasalazine (70, 23.6%), Methotrexate (MTX) (21, 7.1%), Azathioprine (AZA) (5, 1,7%), Leflunomide (1, 0.3%) or associations between Sulfasalazine and AZA or MTX. Regarding the iTNF the majority of patients initiate Adalimumab (n=168, 28.6%), Golimumab (n= 61, 25.6%) or Infliximab (n= 57, 23.9%). The majority of patients had very high or high disease activity at baseline (59.6% and 31.3%, respectively); mean ASDAS CRP was 3.85 (± 0.99), mean ESR was 30.1 mm/h (± 21.9) and mean CRP was 36.9 mg/L (±113.9). The post-treatment mean ESR, CRP, ASDAS-CRP, ASDAS-ESR and BASDAI were significantly lower than mean baseline values, as they were also for NLR, MLR and PLR (p&lt;0.01). At the baseline evaluation, in anti-TNF naïve patients, NLR and MLR were positively correlated with the majority of parameters evaluated: ESR level (r=0.322; r=0.203, p&lt;0.01 respectively), CRP level (r= 0.475; r=0.221, p&lt;0.01 respectively), ASDAS-CRP (r=0.255; r=0.192, p&lt;0.01 respectively), ASDAS-ESR (r=0.257; r=0.206, p&lt;0.01 respectively) and BASMI (r=0.288; r=0.150, p&lt;0.01 respectively). No correlations were found with BASDAI. PLR was positively correlated with ESR level (r=0.379, p&lt;0.01), CRP level (r= 0.331, p&lt;0.01), ASDAS-CRP (0.215, p&lt;0.01) and ASDAS-ESR (r=0.208, p&lt;0.01). No correlations were found between those parameters and ELR or BLR. At the evaluation 6 months after introducing a TNFi, we found less and weaker correlations than in naïve patients: NLR and PLR correlate positively with CRP (r=0.302; 0.315, p&lt;0.01 respectively) and, reaching lower statistical significance, PLR correlate also with ASDAS-ESR (0.156, p&lt;0.05); NLR with BASMI (0.184, p&lt;0.05) and ESR (0.179, p&lt;0.05); MLR with CRP (0.173, p&lt;0.05). <h3>Conclusion</h3> NLR, MLR and PLR may reflect disease activity and could represent future inexpensive potential parameters to evaluate disease activity or severity in SpA. <h3>Disclosure of Interests</h3> None declared