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
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.
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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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