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Published on: February 7, 2025
Red Cell Distribution Width and Absolute Lymphocyte Count Associate With Biomarkers of Inflammation and Subsequent
Alyssa Lange1, Lenche Kostadinova1, Sofi Damjanovska1
1A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University.
High red cell distribution width (RDW) and low absolute lymphocyte count (ALC) before rheumatoid arthritis (RA) treatment predict mortality. These hematologic markers are linked to inflammation and patient outcomes.
Area of Science:
- Rheumatology
- Immunology
- Hematology
Background:
- Rheumatoid arthritis (RA) management aims to maintain immune and hematologic homeostasis to mitigate morbidity and mortality.
- Identifying patients at risk for adverse outcomes in RA remains a challenge.
- Red cell distribution width (RDW) and absolute lymphocyte count (ALC) are associated with cardiovascular disease and mortality in the general population and disease activity in RA.
Purpose of the Study:
- To investigate the relationship between RDW, ALC, inflammation, and mortality in patients with rheumatoid arthritis.
- To determine if RDW and ALC can serve as predictive markers for mortality risk in RA patients.
Main Methods:
- A retrospective cohort study of 327 RA patients treated with methotrexate (MTX) +/- tumor necrosis factor inhibitor (TNFi) at a VA Rheumatology Clinic.
- Evaluation of RDW and ALC before and during therapy, correlated with subsequent mortality.
- Validation in a national VA cohort (n=13,914) and analysis of inflammatory markers in a subset of patients and controls.
Main Results:
- High RDW and low ALC prior to MTX treatment were significantly associated with 10-year mortality in both local and national RA cohorts (P < 0.001).
- The highest mortality risk was observed in patients with both high RDW and low ALC, even after adjusting for confounders.
- RDW correlated with age and ALC, while ALC correlated with inflammatory markers including TNF receptor II.
- MTX treatment increased RDW and decreased ALC; TNFi addition to MTX increased ALC.
Conclusions:
- Pre-treatment RDW and ALC levels in RA patients are associated with biomarkers of inflammation and predict subsequent mortality.
- These findings highlight the potential of RDW and ALC as accessible prognostic tools in RA management.
- Further research is warranted to elucidate the mechanistic link between TNF signaling, lymphopenia, and mortality in RA.
