The Relationship Between Peripheral Blood Cell Ratio And Disease Activity And Therapeutic Effect Of Infliximab In Rheumatoid Arthritis

Part I The Relationship between Peripheral Blood Cell Ratio and Disease Activity in RAObjectiveThe objective of this study was to investigate the relationship between the peripheral blood parameters of neutrophil/lymphocyte(NLR),platelet/lymphocyte(PLR),lymphocyte/monocyte Ratio(LMR)and disease activity in RA.MethodsA retrospective study was conducted on 99 patients with active RA who visited the Department of Rheumatology and Immunology of the First Affiliated Hospital of Jinan University from December 2019 to December 2021.The 28 joint disease activity score(disease activity score-28 joints,DAS28)scale was used to evaluate the disease activity of RA patients.The activity was divided into low disease activity group(n=33)and medium/high disease activity group(n=66).100 healthy subjects were selected as the control group.The peripheral blood cell ratios of active RA patients and healthy control groups were collected,the differences of peripheral blood cell ratios between active RA group and healthy control groups were analyzed,and the correlation between peripheral blood cell ratios and RA group activity was further analyzed.Results1.NLR and PLR in active RA group were higher than those in healthy control group(NLR:2.4±1.4 vs.1.7±0.6,P < 0.001;PLR:163.8±77.1 vs.128.2±90.0,P < 0.001).LMR in active RA group was lower than that in healthy control group(4.1 ±1.9 vs.5.9 ±2.0,P < 0.001).2.NLR and PLR in low disease activity group were lower than those in medium / high disease activity group(NLR:1.7±1.2 vs.2.8±1.2,P < 0.001;PLR:135.3±78.4 vs.178.3±73.5,P < 0.001).LMR in low disease activity group was higher than that in medium / high disease activity group(4.5 ±1.1 vs.3.9 ±2.2,P < 0.001).3.NLR was positively correlated withDAS28-ESR,ESR and CRP(r = 0.440,P < 0.001;r = 0.281,P = 0.006 and r = 0.318,P =0.001).PLR was positively correlated with the above inflammatory markers(r = 0.438,P < 0.001;r = 0.318,P = 0.002 and r = 0.300,P < 0.001),and LMR was negatively correlated with the above inflammatory markers(r =-0.333,P = 0.001;r =-0.305,P = 0.003 和 r =-0.225,P = 0.027).ConclusionNLR,PLR and LMR in peripheral blood of patients with active RA are related to the disease activity of RA,which will be helpful to evaluate the disease activity of RA.Part II Clinical Study of Peripheral Blood Cell Ratio and the Efficacy of InfliximabObjective1.To investigate the effect of infliximab on DAS28,NLR,PLR and LMR in patients with active RA.2.To explore the correlation between NLR,PLR,LMR and clinical efficacy of infliximab.MethodsFifty-three cases of active RA patients who were hospitalized in the Department of Rheumatology and Immunology of the First Affiliated Hospital of Jinan University from December 2019 to December 2021 and received infliximab standardized treatment for 14 weeks were selected as study subjects for retrospective study.And the changes of NLR,PLR,LMR,ESR,CRP and DAS28-ESR before and after treatment were calculated.The clinical response was evaluated by EULAR treatment response criteria,which was divided into clinical response group and clinical non-response group according to the decrease of DAS28-ESR > 1.2.To investigate the changes of NLR,PLR and LMR before and after treatment and to compare the changes of NLR,PLR and LMR after treatment in the two groups,respectively,and to analyze the correlation between the changes of NLR,PLR and LMR and the efficacy of infliximab.Results1.The levels of ESR,CRP,DAS28-ESR,NLR and PLR in RA patients treated with infliximab for 14 weeks were significantly higher than those in baseline phase(P < 0.01).2.After 14 weeks of infliximab treatment,NLR and PLR in patients with RA were significantly lower than those in the baseline period(NLR:2.6±1.0 vs.2.1±1.3,P < 0.05,PLR:181.9±74.0 vs.131.1±61.1,P < 0.01),and LMR was significantly higher than that in the baseline period(4.1±1.6 vs.4.4±1.9,P < 0.01).3.The patients were divided into clinical response group and clinical non-response group.There was no significant difference in NLR,PLR and LMR between clinical response group and non-response group before treatment.After treatment,NLR and PLR in clinical response group were lower than those in non-response group(NLR:2.3±1.4 vs.2.7 ±2.1,P < 0.01,PLR:130.5 ±77.3 vs.135.9 ±66.9,P < 0.01),and LMR in clinical response group was higher than that in non-response group(4.4±1.9 vs.4.0±2.3,P < 0.01).ConclusionNLR,PLR and LMR may be related to the clinical efficacy of infliximab and can be used as biomarkers to evaluate the efficacy.