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Assessing disease activity in polymyalgia rheumatica using the systemic immune-inflammation index: A retrospective
Sibel Ösken1, Başak Bilir Kaya2
1Department of Rheumatology, Istanbul Erenköy Physical Therapy and Rehabilitation Hospital, Merdivenköy, Ressam Salih Erimez Cad No:21, 34732, Kadıköy, Istanbul, Türkiye. sibeltos@yahoo.com.
Background:
Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition predominantly affecting older individuals, characterized by pain and stiffness in the shoulder and pelvic girdles. The PMR Activity Score (PMR-AS) is a composite tool for assessing disease activity, yet easily accessible inflammatory biomarkers that correlate with disease activity remain limited. The Systemic Immune-Inflammation Index (SII), derived from peripheral blood counts has emerged as a novel marker reflecting systemic inflammation.
Objective:
To investigate the relationship between the SII index and disease activity as measured by the PMR-AS in patients diagnosed with PMR.
Methods:
In this retrospective cross-sectional study, 180 patients diagnosed with PMR were included. Clinical and laboratory data at diagnosis were analyzed. PMR-AS was calculated at baseline. Pretreatment complete blood counts were used to determine the SII index. The association between SII index and PMR-AS was evaluated using Pearson correlation analysis. Patients were stratified into low disease activity and moderate-high disease activity groups based on a PMR-AS cut-off of 7. Multivariate linear regression was conducted to evaluate the independent association between SII index and PMR-AS.
Results:
Among 180 patients with PMR, 86 (47.8%) had moderate-high disease activity. Coronary artery disease (CAD) was significantly more common in this group. Patients with moderate-high disease activity showed elevated WBC and neutrophil counts, reduced lymphocyte counts, and higher CRP levels. The SII index was markedly higher in the moderate-high disease activity group and demonstrated a moderate correlation with PMR-AS (r = 0.47). In multivariate analysis, CAD and SII index were independent predictors of moderate-high disease activity. ROC analysis confirmed that SII index demonstrated acceptable discriminatory performance moderate-high disease activity.
Conclusion:
The SII index may reflect disease activity in PMR and could be considered a non-invasive, cost-effective adjunct to clinical evaluation. Key Points • The SII index is a powerful predictor of disease activity in PMR. • Presence of CAD and higher SII index were independently associated with moderate-high disease activity, highlighting systemic inflammation. • Routine assessment of SII index may improve disease monitoring in PMR, supporting its integration into clinical evaluation alongside established disease activity scores.
Insights
The Systemic Immune-Inflammation Index (SII) correlates with disease activity in polymyalgia rheumatica (PMR). Higher SII levels indicate greater PMR disease activity, offering a potential non-invasive marker for monitoring patients.
Area of Science:
- Rheumatology
- Immunology
- Biomarker Discovery
Background:
- Polymyalgia rheumatica (PMR) is a common inflammatory condition in older adults, causing shoulder and pelvic girdle pain and stiffness.
- Current assessment tools like the PMR Activity Score (PMR-AS) exist, but accessible inflammatory biomarkers for disease activity are limited.
- The Systemic Immune-Inflammation Index (SII), calculated from routine blood counts, is a novel marker of systemic inflammation.
Purpose of the Study:
- To evaluate the correlation between the Systemic Immune-Inflammation Index (SII) and disease activity, measured by the PMR Activity Score (PMR-AS), in patients with polymyalgia rheumatica (PMR).
Main Methods:
- A retrospective cross-sectional study involving 180 PMR patients.
- Analysis of clinical and laboratory data at diagnosis, including complete blood counts for SII calculation and PMR-AS.
- Pearson correlation and multivariate linear regression to assess the association between SII and PMR-AS, with stratification based on disease activity.
Main Results:
- The Systemic Immune-Inflammation Index (SII) was significantly higher in patients with moderate-to-high PMR disease activity.
- SII showed a moderate positive correlation with the PMR Activity Score (PMR-AS) (r=0.47).
- Both SII and coronary artery disease (CAD) were identified as independent predictors of moderate-to-high disease activity in multivariate analysis.
Conclusions:
- The Systemic Immune-Inflammation Index (SII) appears to be a valuable, non-invasive indicator of disease activity in polymyalgia rheumatica (PMR).
- Higher SII levels, along with the presence of CAD, are independently associated with increased PMR disease activity, underscoring systemic inflammation.
- Routine assessment of SII may enhance disease monitoring and clinical evaluation in PMR patients.
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