Date: Monday, October 22, 2018
Session Type: ACR Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose: To assess whether the neutrophil-lymphocyte ratio (NLR) can predict those who require disease modifying therapy escalation and hence progression in rheumatoid arthritis (RA).
Methods: Patients with newly diagnosed RA were recruited from the Early Arthritis Clinic at the Royal Adelaide Hospital. Those who were on glucocorticoids at the time of review were excluded. All patients were commenced on methotrexate, sulphasalazine and hydroxychloroquine and were reviewed at regular intervals, and Disease Modifying Anti-Rheumatic Drug (DMARD) therapy was adjusted according to a set algorithm. The NLR, platelet-lymphocyte ratio (PLR) and other markers of disease activity such as the ESR, CRP and DAS28 were collected as well as current therapy. The primary outcome measure was failure of triple DMARD therapy.
Results: Two-hundred and twenty-two patients met inclusion criteria. The mean age was 54.2±15.4 years with a mean duration of polyarthritis of 22.3±25.0 weeks prior to their first review. Forty-five (20%) of patients had failed triple therapy by one year. The mean NLR was significantly higher in those who failed triple therapy when compared to those that did not (3.7±2.8 vs 2.9±1.5; p=0.02), however, the PLR was not significantly different (184.1±78.6 vs 171.4±84.5; p=0.41). The NLR was an independent predictor of treatment failure (OR 2.65, CI 1.23-5.72, p=0.01) whilst the PLR, ESR, CRP and DAS-28ESR were not (p-values 0.41, 0.13, 0.17 and 0.28 respectively).
Conclusion: The NLR is significantly increased in those with treatment failure in RA and outperforms more conventional markers of disease activity. The NLR may be a cheap, objective and reproducible prognostic marker, however, further prospective studies are required to identify the role of the NLR in RA disease management algorithms.
To cite this abstract in AMA style:Boulos D, Metcalf R, Proudman S, Wicks I. The Neutrophil-Lymphocyte Ratio in Newly Diagnosed Rheumatoid Arthritis and Its Ability to Predict Treatment Failure [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/the-neutrophil-lymphocyte-ratio-in-newly-diagnosed-rheumatoid-arthritis-and-its-ability-to-predict-treatment-failure/. Accessed January 21, 2020.
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