Elsevier

International Immunopharmacology

Volume 62, September 2018, Pages 293-298
International Immunopharmacology

Two new inflammatory markers associated with disease activity score-28 in patients with rheumatoid arthritis: Albumin to fibrinogen ratio and C-reactive protein to albumin ratio

https://doi.org/10.1016/j.intimp.2018.07.007Get rights and content

Highlights

  • AFR were lower and CAR were higher in RA patients with active disease.

  • AFR and CAR were significantly correlated with NLR, PLR, CRP and ESR in RA patients.

  • AFR was related with decreased risk of RA disease activity.

  • AFR and CAR were novel inflammatory markers for diagnosing RA disease activity.

Abstract

Background

The albumin to fibrinogen ratio (AFR) and C-reactive protein to albumin ratio (CAR) have emerged as useful biomarkers to predict systemic inflammation. The aim here is to investigate the relation between AFR/CAR and Disease Activity Score of 28 joints (DAS 28) in rheumatoid arthritis (RA).

Methods

This retrospective study included 160 patients with RA and 159 healthy controls. We divided the RA patients into two groups according to the DAS 28-ESR score. Group 1 included 40 patients with a score of lower than 2.6 (patients in remission) and Group 2 included 120 patients with a score of 2.6 or higher (patients with active disease). The correlations between AFR, CAR and the disease activity were analyzed.

Results

For RA patients, the AFR was lower than those in the control group (P < 0.001). Patients in group 2 had higher CAR than those in group 1 (P < 0.001). The AFR was lower in group 2 than that in group 1. A positively correlation was observed between DAS 28-ESR score and CAR (r = 0.645, P < 0.001), while the correlation between DAS 28-ESR and AFR (r = −0.836, P < 0.001) was negative. AFR was related with decreased risk of RA disease activity (EXP (B) = 0.33, 95% CI (0.21–0.53), P < 0.001).

Conclusions

AFR and CAR are two novel inflammatory markers for monitoring disease activity in patients with RA.

Introduction

Rheumatoid arthritis (RA) is an autoimmune disease with chronic inflammation of the synovial joints that marked by variable cycles of remissions and relapses and eventually induced severe disability [1,2]. The Epidemiologic evidence confirmed that the disease activity level and the duration of remission effect the subsequent progression of RA [3]. Therefore, the assessment of disease activity is crucial for the clinical decision and long-term outcome of RA patients. Currently, the most commonly used markers are clinical symptoms or signs, questionnaires and laboratory tests [4], thereinto, the levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are the most widely used laboratory indicators for RA disease-activity assessment [5]. However, both of them have several limitations. For example, they are reflection of short-term inflammatory activity and cannot distinguish with other superimposed inflammatory conditions [[6], [7], [8]].

Recently, Systemic inflammation has been reported to correlate with inflammation-based scores, including the platelet to lymphocyte ratio (PLR), the neutrophil to lymphocyte ratio (NLR), the red cell distribution width (RDW) and the mean platelet volume (MPV) [[9], [10], [11]]. A high CRP level and a low albumin (ALB) level may correlate with chronic and severe inflammation. And several studies have showed that the new inflammation based score, the CRP to ALB ratio (CAR), are associated with the inflammatory status [12,13]. More recently, several cases have been reported that the level of fibrinogen (Fib) was significantly increased and the ALB level was lower in RA patients [14,15]. This may be due to the fact that the albumin to fibrinogen ratio (AFR) emerged as a useful biomarker to predict inflammation condition. However, the CAR and AFR acting as useful indicator for monitoring disease activity in systemic inflammatory diseases including RA have been scarcely studied.

Therefore, the aim of this retrospective study was to simultaneously investigate whether CAR or AFR correlates with disease activity in patients with RA.

Section snippets

Subjects

A total of 160 patients with RA from the Second Affiliated Hospital of Nanchang University from January 2011 to December 2016 were enrolled in this retrospective study. All RA patients were diagnosed by the criteria of the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 [16]. All patients hadn't received treatment within the last 3 months. Patients who had systemic diseases, such as hematologic diseases, diabetes mellitus, blood transfusion, malignancies,

Basic characteristics and laboratory measurements of the subjects

The demographic characteristics and hematologic parameters for the patients and control groups were shown in Table 1. The patients included 49 males (30.62%) and 111 females (69.38%), with the mean age of 52.86 ± 12.89 years, while the control group contained 51 males (32.08%) and 108 females (67.92%), with the mean age of 53.64 ± 12.31 years. No significant differences were observed in age (P = 0.580) and gender (P = 0.780) between the two groups. RA patients had an AFR of 9.18 ± 2.83, a CAR

Discussion

The present study was designed to assess the correlations of NLR, PLR, CAR and AFR with disease activity in patients with RA. Our results showed that NLR and PLR were higher in RA patients than those in control group. And we identified a significantly decreased AFR in RA patients. According to DAS 28-ESR system, NLR, PLR and CAR were lower in patients in remission than those patients with active disease and AFR was higher in patients in remission. Another novel finding was that CAR was

Conflict of interest statement for all authors

The authors proclaim that they have no conflict of interest in conducting this study and publishing the results presented in this paper.

Acknowledgments

This work was supported by the National Natural Science Foundation of China (No. 81360083 and No. 81401964), Jiangxi Government Foundation for Youth Natural Sciences (No. 20142BAB215058 and No. 20171BAB215042) and Jiangxi Provincial Department of Education (No. GJJ14185).

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