Hematological Indices as Biomarkers in Patients With Rheumatoid Arthritis but Normal ESR/CRP Receiving...

Area of Science:

• Rheumatology
• Immunology
• Hematology

Background:

• Hematological indices, including neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and neutrophil-to-hemoglobin and lymphocyte (NHL), are recognized for assessing rheumatoid arthritis (RA) disease activity.
• Biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) are crucial for managing RA, necessitating effective monitoring tools.

Purpose of the Study:

• To evaluate the utility of NLR, SII, and NHL as biomarkers for monitoring treatment response and disease improvement in RA patients undergoing b/tsDMARD therapy.
• To assess the predictive value of these hematological indices for treatment outcomes.

Main Methods:

• A retrospective analysis of 308 active RA patients treated with various b/tsDMARDs (IL-6 receptor inhibitors, TNF-alpha inhibitors, abatacept, JAK inhibitors).
• Collection of hematological indices at baseline and 6 months post-treatment.
• Correlation of index changes with DAS28-ESR scores and assessment of their ability to discriminate responders from non-responders.

Main Results:

• Significant reductions in NLR, SII, and NHL were observed post-b/tsDMARD initiation.
• These indices correlated with improved DAS28-ESR scores and effectively differentiated treatment responders.
• The indices demonstrated good predictive value for DAS28-ESR reduction (AUC 0.709-0.732) and improved sensitivity when combined with ESR.
• In patients with active RA but normal ESR/CRP, these indices (sensitivity 54.8%-66.1%) better reflected disease burden and treatment response than traditional markers (sensitivity 29.0%).

Conclusions:

• NLR, SII, and NHL are valuable biomarkers for assessing treatment response in RA patients receiving b/tsDMARDs.
• These indices enhance the evaluation of disease improvement when used alongside ESR.
• They are particularly useful for monitoring treatment-related changes in patients with active disease but normal ESR/CRP, serving as alternative or complementary indicators.