Relationship between monocytes to lymphocytes ratio and axial spondyloarthritis
Introduction
Axial spondyloarthritis (AxSpA) is a progressive, chronic, inflammatory disease that mainly affects the axial skeleton and sacroiliac joints [1,2]. AxSpA includes nonradiographic axial spondyloarthritis (Nr-axSpA) and ankylosing spondylitis (AS), and Nr-axSpA is the early stages of the disease [3]. The common clinical manifestations of axSpA are chronic inflammatory back pain, sacroiliitis, spondylitis, and restrictions in spine movement [4]. Although the pathogenesis of axSpA is still unclear, about 90% of AS patients carry human leukocyte antigen (HLA)-B27. HLA-B27 is widely accepted as a routine clinical biomarker of AS [5]. However, with effective disease-modifying treatments such as tumor necrosis factor inhibitors becoming widely available for AS, early diagnosis is urgently required to reduce disease burden.
Many studies have shown that the immune and inflammatory systems are often activated in axSpA patients [6,7]. Serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels are increased in peripheral joint inflammation, which are useful biomarkers for determining the degree of inflammatory disease activity over time [8,9]. However, they have low sensitivity and specificity, with the limitations of short-term inflammatory activity and low discrimination ability. It has been reported that neutrophils, lymphocytes, monocytes, platelets, and red blood cells (RBCs) play important roles in the inflammatory process of axSpA [[10], [11], [12]]. Neutrophils to lymphocytes ratio (NLR) and red blood cell distribution width (RDW) have been reported to be simple and inexpensive markers to indicate the disease activity of axSpA [13,14]. Monocytes to lymphocytes ratio (MLR) and platelets to lymphocytes ratio (PLR), which can be easily calculated from the peripheral blood, have also been demonstrated to be novel systemic inflammatory indicators of disease severity in many diseases, such as Behçet's disease and cancer [[15], [16], [17]]. However, no study has focused on the role of MLR and PLR in axSpA.
Therefore, our study aims to investigate the role of MLR and PLR in axSpA patients and their relationships with disease severity.
Section snippets
Participants characteristics
A total of 148 patients, fulfilling the 2009 Assessment in Ankylosing Spondylitis International Society classification criteria for the diagnosis of axSpA (male to female ratio: 116/32, mean 29.9 ± 8.8 years) and 58 healthy controls (male to female ratio: 43/15, mean 29.8 ± 6.9 years) between April 2016 and June 2017 were enrolled in the study. The enrolled AS patients fulfilled the modified 1984 New York criteria. Those who had malignancy, active infection, diabetes mellitus, hypertension,
Basic characteristics of axSpA patients and healthy subjects
A total of 148 axSpA patients and 58 healthy subjects were included in the study. There was no statistically significant difference between the two groups in terms of age and gender. The number of WBCs, neutrophils, monocytes, platelets, and RDW in the axSpA group were higher than those in the control group, while the number of lymphocytes, RBCs, and hemoglobin level were lower (P < 0.05). The disease duration was (5.6 ± 5.9) years, ESR level was (32.3 ± 30.4) mm/h, CRP level was (17.5 ± 22.5)
Discussion
As the effective disease-modifying treatments such as TNF inhibitors become widely available for AS, early diagnosis is urgently required in reducing disease burden. In our study, we found that all MLR, NLR, PLR, and RDW were increased in axSpA patients—among them, MLR was highly increased in AS patients and had a close relationship with ESR level, CRP level, and spine activity.
Complete blood count is an easy, inexpensive, routine examination technique that provides information about the blood
Acknowledgements
This study was supported by a talent development fund from Guangdong Second Provincial General Hospital (No. 2014001), Science and Technology Planning Project of Guangdong Province (No. 20130319c), Medical Scientific Research Foundation of Guangdong Province (No. A2017551), Natural Science Foundation of Guangdong Province (No.2017A030313526).
Conflict of interest
The authors declare that they have no conflict of interest.
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Yukai Huang and Weiming Deng have contributed equally to this work.