A Study of Correlation of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Lymphocyte-Monocyte Ratio with Disease Activity in Patients of Rheumatoid Arthritis

Abstract

Background: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder characterized by synovial inflammation and joint destruction. Disease Activity Score in 28 joints (DAS28) is commonly used to monitor disease activity, but there is growing interest in simpler, cost-effective hematological markers such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) for disease monitoring.

Objective: To evaluate the correlation of NLR, PLR, and LMR with disease activity in patients with RA using DAS28 score.

Materials and Methods: This prospective observational cohort study included 135 RA patients diagnosed based on 2010 ACR/EULAR criteria. Clinical evaluation, DAS28 scoring, complete blood count, ESR, CRP, and calculation of NLR, PLR, and LMR were performed at baseline and after treatment during follow-up. Statistical analysis included paired t-tests and Pearson’s correlation.

Results: A statistically significant decrease in DAS28 score was observed from baseline to follow-up (p = 0.001), indicating clinical improvement. NLR and PLR values significantly increased from baseline to follow-up (p = 0.001 and p = 0.029 respectively), and both showed a significant positive correlation with DAS28 scores (NLR: r = 0.411, p = 0.010; PLR: r = 0.514, p = 0.001). LMR showed a nonsignificant decrease (p = 0.213) and a weak, nonsignificant negative correlation with DAS28 (r = -0.197, p = 0.233).

Conclusion: NLR and PLR are significantly correlated with RA disease activity and may serve as convenient, cost-effective markers in routine clinical practice. LMR appears to have limited utility in assessing disease activity. Further studies with larger sample sizes and extended follow-up are warranted.