Metabolic syndrome,hematological markers of inflammation and disease activity in rheumatoid arthritis

Abstract

Background: The coexistence of Rheumatoid Arthritis (RA) and Metabolic Syndrome (MetS) is common. Aim: The present study assessed the effect of MetS on disease activity and hematological markers of inflammation to Platelets/Lymphocyte Ratio (PLR) and Neutrophil/Lymphocyte Ratio (NLR) in RA patients. Study design: A cross-sectional case control study using STARD reporting guideline. Methods: The present study included 5 groups: treatment-naive RA patients with MetS (GI, n=50), treated RA patients with MetS (GII, n=50), treatment-naive RA patients without MetS (GIII, n=50), treated RA patients without MetS (GIV, n=50) and healthy age and sex-matched controls (GV, n=50). RA was diagnosed based on the 2010 ACR/EULAR criteria. Disease activity of RA patients was calculated using the DAS-28 score. For the diagnosis of MetS, we adopted the Harmonized Joint Scientific Statement (HJSS) on metabolic syndrome recommendations. Results: Patients in GI had significantly higher DAS28 when compared with other groups. GII and GIII patients had significantly higher DAS28 when compared with GIV. It was also shown that GI patients had significantly higher PLR and NLR when compared with GIII. Similarly, GII patients had significantly higher PLR and NLR when compared with GIV. Logistic regression analysis identified presence only MetS [OR (95%CI): 8.66 (1.34-56.1), p=0.024] and increased PLR (OR (95%CI): 0.98 (0.96-0.99), p=0.002) as independent predictors of high disease activity in treatment-naive patients while increased PLR was the only independent predictor of disease activity in treatmentexperienced patients. Conclusion: Metabolic syndrome is associated with elevated hematological markers of inflammation and disease activity in treatment-naive RA patients. Both PLR and NLR are risk factors for RA activity in treatment-naive patients with PLR being more strongly correlated with disease activity.