Mean Platelet Volume and Neutrophil Lymphocyte Ratio as Related to Inflammation Markers and Anti-CCP in Rheumatoid Arthritis

Abstract

Background: Various thrombocyte markers and white blood cell levels and their subtypes have recently been investigated in association with inflammation. The purpose of this study was to determine the correlation of mean platelet volume (MPV) and neutrophil/lymphocyte ratio (NLR) with disease activation and clinical para­meters in rheumatoid arthritis (RA) patients.

Methods: 84 RA patients and 60 healthy controls were included. Platelet, MPV, white cell, neutrophil and lymphocyte levels in full blood counts were investigated, and NLR was calculated. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), disease activation score (DAS 28) and a health assessment questionnaire (HAQ) were used in the evaluation of RA.

Results: In the present study a total of 144 patients was enrolled, 84 with RA and 60 healthy individuals. 75.2% (n=108) were women and 24.8% (n=36) were men. The patients with RA had lower MPV than control individuals (MPV; 8.52±1.15 fL and 8.92±0.87 fL, respectively) and CRP (r:−0.234, p=0.005). RA patients’ mean NLR was significantly higher than that of the control group (2.74±1.74 and 1.80±0.78, respectively; p<0.001). Furthermore, anti-CCP positive patients had higher NLR than anti-CCP negative patients (NLR; 2.51±1.92 and 1.95±1.22, p=0.019 respectively). NLR was positively correlated with ESR (r=0.190, p=0.023), CRP (r=0.230, p=0.035) and anti-CCP (r=0.300, p=0.005).

Conclusion: In conclusion, MPV and NLR together with acute phase reactants can be a useful index for showing inflammation in RA patients.

Zusammenfassung

Einleitung: Verschiedene thrombozytäre Marker und Grenzwerte von Leukozyten und ihren Subtypen sind in der jüngeren Vergangenheit bezüglich ihres Zusammenhangs mit Entzündung untersucht worden. Ziel dieser Untersuchung war die Korrelation des mittleren Thrombozytenvolumens (MPV) und der Neutrophilen/Lymphozyten Ratio (NLR) mit der Krankheitsaktivität und klinischen Parametern bei Patienten mit rheumatoider Arthritis (RA).

Methoden: 84 RA Patienten und 60 gesunde Kontrollen wurden eingeschlossen. Aus dem Blutbild wurden Thrombozyten, MPV, Leukozyten-, Neutrophilen- und Lymphozytenwerte untersucht und die NLR errechnet. Die Erythrozytensedimentationsrate (ESR), C-reaktives Protein, Rheumafaktor (RF), anti-zyklisches citrullinieres Peptid (anti-CCP), der Krankheits­aktivität-Score DAS 28 und ein Gesundheitsbewertungsbogen (HAQ) wurden für die Bewertung der RA herangezogen.

Ergebnis: In die vorliegende Studie wurden 144 Patienten eingeschlossen, 84 mit RA und 60 gesunde Kontrollen. 75,2% (n=108) waren Frauen und 24,8% (n=36) waren Männer. Patienten mit RA hatten ein niedrigeres MPV als die Kontrollen (MPV; 8,52±1,15 fL bzw. 8,92±0,87 fL) und CRP (r:−0,234, p=0,005). Die mittlere NLR von RA Patienten war signifikant höher als die der Kontrollgruppe (2,74±1,74 bzw. 1,80±0,78; p<0,001). Außerdem hatten anti-CCP positive Patienten höhere NLRs als anti-CCP negative Patienten (NLR; 2,51±1,92 bzw. 1,95±1,22 p=0,019). Die NLR korrelierte positiv mit der ESR (r=0,190, p=0,023), dem CRP (r=0,230, p=0,035) und dem anti-CCP (r=0,300, p=0,005).

Schlussfolgerung: MPV und NLR können gemeinsam mit Akutphase-Proteinen ein hilfreicher Index für die Entzündungsaktivität bei RA Patienten sein.

Key words

rheumatoid arthritis - mean platelet volume - neutrophil-to-lymphocyte ratio - inflammation

Schlüsselwörter

Rheumatoide Arthritis - Mittlere Plättchenvolumen - Neutrophilen-to-­Lymphozyten-Verhältnis - Entzündung

• References

• 1 O’Dell JR. Rheumatoid arthritis: The clinical Picture. In Koopman WJ. Arthritis and Allied Conditions. Philadelphia: Lippincott Williams & Wilkins; 2001: 1157-1186
• 2 Colglazier CL, Sutej PG. Laboratory testing in the rheumatic diseases: a practical review. South Med J 2005; 98: 185-191
• 3 Wagner DD, Burger PC. Platelets in inflammation and thrombosis. Arterioscler Thromb Vasc Biol 2003; 23: 2131-2137
• 4 Sprague DL, Elzey BD, Crist SA et al. Platelet mediated modulation of adaptive immunity: unique delivery of CD154 signal by platelet-derived membrane vesicles. Blood 2008; 111: 5028-5036
• 5 Semple JW, Freedman J. Platelets and innate immunity. Cell Mol Life Sci 2010; 67: 499-511
• 6 Ardoin SP, Shanahan JC, Pisetsky DS. The role of microparticles in inflammation and thrombosis. Scand J Immunol 2007; 66: 159-165
• 7 Palatinus A, Adams M. Thrombosis in systemic lupus erythematosus. Semin Thromb Hemost 2009; 35: 621-629
• 8 Gasparyan AY, Stavropoulos-Kalinoglou A, Mikhailidis DP et al. Platelet function in rheumatoid arthritis: arthritic and cardiovascular implications. Rheumatol Int 2011; 31: 153-164
• 9 Milovanovic M, Nilsson E, Järemo P. Relationships between platelets and inflammatory markers in rheumatoid arthritis. Clin Chim Acta 2004; 343: 237-240
• 10 Zahorec R. Ratio of neutrophil to lymphocyte counts – Rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001; 102: 5-14
• 11 Tamhane UU, Aneja S, Montgomery D et al. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008; 102: 653-657
• 12 Ahsen A, Ulu MS, Yuksel S et al. As a New Inflammatory Marker for Familial Mediterranean Fever: Neutrophil-to-Lymphocyte Ratio. Inflammation 2013; 36: 1357-1362
• 13 Uslu AU, Deveci K, Korkmaz S et al. Is Neutrophil/Lymphocyte Ratio Associated with Subclinical Inflammation and Amyloidosis in Patients with Familial Mediterranean Fever?. BioMed Research International 2013;
• 14 Aletaha D, Ward MM, Machold KP et al. Remission and active disease in rheumatoid arthritis. Defining criteria for disease activity states. Arthritis Rheum 2005; 52: 2625-2636
• 15 Küçükdeveci A, Şahin H, Ataman Ş et al. Issue in cross-cultural validity: example from the adaptation, reliability, and validity testing of a Turkish version of the Stanford Health Assessment Questionnaire. Arthritis & Rheum 2004; 51: 14-19
• 16 Gasparyan AY, Ayvazyan L, Mikhailidis DP et al. Mean platelet volume: a link between thrombosis and inflammation?. Curr Pharm Des 2011; 17: 47-58
• 17 Pitchford SC, Page CP. Platelet activation in asthma: integral to the inflammatory response. Clin Exp Allergy 2006; 36: 399-401
• 18 Kisacık B, Tufan A, Kalyoncu U et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine 2008; 75: 291-294
• 19 Yazici S, Yazici M, Erer M et al. The platelet indices in patients with rheumatoid arthritis: mean platelet volume reflects disease activity. Platelets 2010; 21: 122-125
• 20 Gasparyan AY, Sandoo A, Stavropoulos-Kalinoglou A et al. Mean platelet volume in patients with rheumatoid arthritis: the effect of anti-TNF-α therapy. Rheumatol Int 2010; 30: 1125-1129
• 21 Vencovsky J, Machacek S, Sedova L et al. Autoantibodies can be prognostic markers of an erosive disease in early rheumatoid arthritis. Ann Rheum Dis 2003; 62: 427-430