الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 123 |  |  |
| | | from | 123 | | |
Abstract
Rheumatoid arthritis is an autoimmune disease characterized by chronic inflammation which affects synovial joints leading to bone damage, disability and cardiovascular events and mortality. Different cells such as neutrophils, lymphocytes and platelets are proven to be involved in regulation of inflammatory process and immune mediated pathways of chronic diseases. NLR, pLR and LMR were recently examined as assessment tools for disease activity in rheumatoid arthritis.
This case-control study was performed for 120 RA patients (108 females and 12 males) in addition to 50 healthy controls (44 females and 6 males) to evaluate NLR, PLR and LMR in patients with RA and their relation to different disease activity scores.
The most common presenting symptoms were arthralgia (90%), morning stiffness (53.3%), arthritis (47.5%), and extra-articular manifestations (22.5%).Most of the included RA patients were on methotrexate and hydroxychloroquine (25.84%) followed by Leflunomide and hydroxychloroquine (24.16%), Methotrexate (21.67%) and Leflunomide (15.83%).
assessment of Disease activity of the included rheumatoid arthritis patients using DAS 28 score showed that most of them had high disease activity while using RADAI-5 score showed that most of the included patients had moderate disease activity.
Rheumatoid arthritis patients in the present study expressed significant increase of neutrophils, platelets, monocytes, ESR, CRP, PLR, and NLR and significant decrease of Hb, lymphocytes, and LMR compared to controls.
Our study revealed statistically significant higher ESR, CRP, platelets, neutrophils and monocytes in RA patients with high DAS-28 score than RA patients in remission.
NLR and PLR significantly increased with increased DAS28 score while LMR significantly decreased with increased DAS 28 score .
DAS 28 score was positively correlated with RADAI-5 and MHAQ scores.
We found statistically significant positive correlation between DAS28 score with WBCs, neutrophils, monocytes, ESR, CRP, PLT, NLR and PLR, and negative correlation between DAS28 score, HB, lymphocytes and LMR.
The current study revealed that PLR had a sensitivity of 95% and a specificity of 80%, NLR had a sensitivity of 89% and a specificity of 82% . And LMR had a sensitivity of 94% and a specificity of 80% for RA patients.
conclusion
NLR, PLR, and LMR may be considered as reliable easily obtained markers for evaluation of RA patients and assessment of diseases activity, as they positively correlate with different disease activity scores including DAS28 and RADAI 5 scores, and inflammatory markers as CRP, and ESR. NLR, PLR, and LMR can significantly differentiate between different degrees of disease activity and remission. Thus Simple CBC with differential count can offer a good, cheap, easy facility for rapid evaluation of RA disease activity.
Recommendations
1- Further longitudinal studies with large sample size are needed for further estimation of The role of NLR, PLR, and LMR in evaluation of RA disease activity.