AB1311 NEUTROPHIL-, MONOCYTE-, EOSINOPHIL- AND BASOPHIL-LYMPHOCYTE RATIOS: ASSOCIATIONS WITH TRADITIONAL INFLAMMATORY MARKERS AND DISEASE ACTIVITY MEASURES AT BASELINE AND 6 MONTHS AFTER A BDMARD AMONG BIOLOGIC-NAÏVE RHEUMATOID ARTHRITISPATIENTS
Authors: Bruno Miguel Fernandes, Salomé Garcia, Raquel Ferreira, Sara Ganhão, Miguel Bernardes, Lúcia Costa
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Neutrophil-lymphocyte (NLR) and monocyte-lymphocyte (MLR) ratios have been not only suggested as systemic inflammatory markers, but also associated with disease activity in some inflammatory diseases. Eosinophil-lymphocyte (ELR) and basophil-lymphocyte (BLR) ratios have been studied to a lesser extent. <h3>Objectives</h3> To correlate NLR, MLR, ELR and BLR with inflammatory markers, other laboratory markers and disease activity measures in a portuguese sample of rheumatoid arthritis (RA) patients. <h3>Methods</h3> We conducted a retrospective study including all RA patients under the first bDMARD (<i>biological disease-modifying antirheumatic drug</i>), followed in a tertiary university hospital and registered in the Rheumatic Diseases Portuguese Register (<i>Reuma.pt</i>). Results of blood tests (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], serum amyloid A [SAA], rheumatoid factor [RF], anti-citrullinated protein autoantibodies [ACPA], haemoglobin, platelets, 25-hydroxide-vitamin D [25OHvitD]), leukocyte formula ratios (NLR, MLR, ELR, BLR) and disease activity and function measures (disease activity score 28 [DAS28 4V, 3V, 4V-CPR, 3V-CPR], clinician and simple disease activity scores [CDAI, SDAI], swollen and tender joint count [SJC, TJC], physician and patient visual analogical scale [VAS]) at baseline and at 6 months of bDMARD therapy were collected. Correlations between variables were evaluated by Spearman rank test (significance level at p&lt;0.05), using SPSS 25.0 software. <h3>Results</h3> 435 patients were included: 81.2% female, mean age at baseline 53.3±11.4 years, mean disease duration 12.6±8.8 years, 72.2% RF positive, 77.1% ACPA positive, 52.5% erosive disease. At baseline, NLR correlated positively with CRP (r=0.343; p&lt;0.001), ESR (r=0.124; p=0.031), RF title (r=0.185; p=0.009), platelets count (r=0.137; p=0.018), DAS28(4V) (r=0.183; p=0.002), DAS28(3V) (r=0.159; p=0.007), DAS28(4V-CRP) (r=0.235; p&lt;0.001), DAS28(3V-CRP) (r=0.222; p&lt;0.001), SDAI (r=0.178; p=0.024), SJC (r=0.120; p=0.040), TJC (r=0.139; p=0.018) and patient VAS (r=0.133; p=0.026). At baseline, we also found a negative correlation between NLR and 25OHvitD levels (r=-0.286; p=0.012). Baseline MLR showed a positive correlation with baseline CRP (r=0.138; p=0.017), RF (r=0.156; p=0.027) and patient VAS (r=0.135; p=0.023). Similarly, at baseline, ELR correlated with CRP (r=0.115; p=0.048) haemoglobin levels (r=0.126; p=0.029) and DAS28(4V-CRP) (r=0.126; p=0.037); and BLR associated positively with DAS28(4V-CRP) (r=0.138; p=0.022), TJC (r=0.121; p=0.038) and patient VAS (r=0.131; p=0.028). At six months of a bDMARD, NLR correlated positively with: CRP (r=0.340; p&lt;0.001), ESR (r=0.140; p=0.018), SAA (r=0.350; p=0.008) and physician VAS (r=0.186; p=0.023). MLR also exhibited a positive association with CRP (r=0.161; p=0.007). Similarly, at six months, ELR correlated positively with CRP (r=0.120; p=0.043), RF (r=0.135; p=0.046), CDAI (r=0.180; p=0.027) and SDAI (r=0.183; p=0.025); and BLR correlated positively with platelets count (r=0.139; p=0.020). <h3>Conclusion</h3> Although weak to moderate in strength, we found significant correlations, between leukocyte formula ratios (NLR, MLR and ELR) and, not only, inflammatory markers but also disease activity measures, predominantly at baseline but also at 6 months of bDMARD. Interestingly, is of note the negative association between NLR and 25OHvitD at baseline. This study reinforced the suggested place of NLR and MLR (but also of ELR) as inflammatory markers and possible disease activity measures in RA. More studies are needed to validate this data. <h3> Disclosure of Interests</h3> None declared