Introduction: Rheumatoid Arthritis ,the most common chronic inflammatory polyarthritis affects 0.5-1%of population, commonly between the age of 30-50 years with a greater propensity to affect females. Diagnosis is based on clinical findings, immunological evidence in form of RA factor or AntiCCP antibodies and inflammatory markers like CRP or ESR levels supported by radiological investigations. Rheumatoid arthritis treatment includes currently the treat to target approach and includes anti-inflammatory drugs, DMARDS (biological and non biological), systemic corticosteroids, surgery and physical rehabilitation. Current treatments require frequent monitoring of disease activity therefore the importance of reliable and simple markers of RA disease activity like neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio, hence the study.

Materials and Method: 50 patients of RA were screened clinically and subjected to evaluation to assess their disease activity using DAS-28(ESR) score as well as NLR and PLR was calculated. The results were compared with a group of age and gender matched healthy individuals as controls. In the patient group NLR and PLR was compared with DAS-28 score as well as ESR in an attempt to find whether NLR and PLR were effective in assessing disease activity.

Results: The NLR and PLR in the RA patient group was significantly higher than controls (2.69 v/s 1.64 and 137.63 v/s 79.04) with a p value of<0.001 and <0.01 respectively. Out of the two, NLR showed a positive correlation with DAS-28 (r=0.329) which was statistically significant (p=0.020) and PLR displayed a positive correlation with DAS-28 score (r=0.077 and p=0.595) which was not significant. Both NLR and PLR showed a positive correlation with ESR which was highly significant (p<0.01 in both).

Conclusion: NLR and PLR are significantly increased in RA patients of rheumatoid arthritis. NLR correlates significantly with DAS-28 score could be used to assess disease activity as an alternative marker. Both NLR and PLR correlate with ESR with high statistical significance in RA patients.

Keywords: Inflammatory Markers, Rheumatoid Arthritis Disease Activity, Neutrophil-Lymphocyte Ratio.

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Bimal K Agrawal

Professor, Department of Medicine,

M M Institute of Medical Sciences and Research, M M University, India