Association of neutrophil to lymphocyte ratio with disease activity indices and musculoskeletal ultrasound findings in recent onset rheumatoid arthritis patients

Aim of the work To study the relation between neutrophil-lymphocyte ratio (NLR) with disease activity indices and with musculoskeletal ultrasonographic findings in recent onset rheumatoid arthritis (RA) patients. Patients and methods The study consisted of 40 recently diagnosed RA patients and 40 matched control. Patients’ disease activity was assessed clinically by the disease activity score (DAS-28). Musculoskeletal ultrasound was performed to detect synovitis by Power-Doppler ultrasound (PDUS). The association of NLR with the disease activity indices and the PDUS score were analyzed. Results The mean age of the patients was 44.5 ± 2.7 years, disease duration 9.4 ± 4.5 months and the female:male ratio was 2.3:1. Their disease activity was 4.7 ± 1.33 and the PDUS score was 10.24 ± 4.56. The NLR was significantly increased in the RA patients (3.28 ± 0.59) compared to the control (1.7 ± 0.23) (p < 0.0002). There was a significant correlation between NLR with the disease duration (p < 0.015), tender joint count (p < 0.022), swollen joint count (p < 0.018), morning stiffness (p < 0.045), visual analogue scale (p < 0.026), DAS-28 (p < 0.049), erythrocyte sedimentation rate (p < 0.032), C-reactive protein (p < 0.017) and PDUS score (p < 0.037). NLR was significantly elevated in highly active RA patients compared to patients with moderate and low disease activity (p < 0.014). Conclusion NLR significantly correlated with disease activity indices in recent onset RA patients thus reflecting systemic inflammation with its advantages of being available, easy and cost accessible being as reliable as the DAS-28 hence it could be used as a marker of disease activity.