Application Of Joint Ultrasound Score Combined With NLR And PLR In The Evaluation Of Disease Activity Of Rheumatoid Arthritis

Objective: To explore the value of joint ultrasound score,neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),and their combined application in the evaluation of rheumatoid arthritis disease activity,Seeking to establish a simplified joint ultrasound scoring system(SUSS),and analyzing the advantages and applicability of SUSS+NLR+PLR combination,to provide theoretical basis for optimizing clinical RA evaluation.Methods: 90 RA patients who visited the First Affiliated Hospital of Dali University from October 2021 to December 2022 were selected as the study subjects,Based on the 28 joint disease activity score(DAS28),they were divided into high activity group(DAS28>5.1),medium activity group(3.2<DAS28≤5.1),low activity group(2.6≤DAS28≤3.2),and remission group(DAS28<2.6).Ultrasound examination was performed on 22 joints of patients in each group,including bilateral wrist joints(Wri),1-5 metacarpophalangeal joints(MCP1-5),and 1-5 proximal fingertip joints(PIP1-5),Observe the synovial hyperplasia,synovial blood flow score,bone erosion,and joint effusion of each joint,and conduct a Szkudlarek level 4 semi quantitative score,At the same time,data on clinical blood testing indicators such as erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),NLR,and PLR were collected.Analyze the correlation between joint ultrasound scores and DAS28,screen combinations with high correlation with DAS28,ESR,and CRP,and establish a new SUSS.Apply the receiver operating characteristic curve(ROC)to describe the discriminative efficacy of SUSS,NLR,PLR,SUSS+NLR,SUSS+PLR,SUSS+NLR+PLR on RA disease activity.Results:(1)There were no significant differences in gender,age,and course of disease among the four groups of RA patients(P>0.05).(2)Compare the various indicators between the four groups in pairs,The number of joint tenderness(TJC)in the high activity group showed statistically significant differences compared to the other three groups(P<0.05),The difference in TJC between the middle activity group and the low activity group was statistically significant(P<0.05);There was a statistically significant difference in the number of joint swelling(SJC)between the low activity group and the high and medium activity groups(P<0.05);The ESR,CRP,NLR,and PLR of the high activity group were significantly higher than the other three groups,and the differences were statistically significant compared to the low activity group and the remission stage group(P<0.05),The differences in ESR,NLR,PLR between the moderate activity group and the remission group were statistically significant(P<0.05).(3)The ultrasound scoring results showed that,The synovial hyperplasia score,synovial blood flow score,and total ultrasound score were between the remission group and the other three groups、The difference between the low activity group and the high activity group was statistically significant(P<0.05),And the remission group was significantly lower than the other three groups;The score of bone erosion was statistically significant between the high activity group and the remission group(P<0.05);There was no statistically significant difference in joint effusion scores between the four groups.(4)The results of correlation analysis between joint ultrasound score and DAS28 score,as well as clinical evaluation indicators,The total ultrasound score and synovial synovial hyperplasia score and synovial hyperplasia score,synovial blood flow score,and bone erosion score were positively correlated with DAS28 score,TJC,SJC,ESR,and CRP scores,respectively(r=0.747,0.534,0.524,0.560,0.420;0.711,0.499,0.509,0.538,0.403;0.782,0.572,0.539,0.577,0.438;0.460,0.364,0.439,0.335,0.234),The correlation between synovial blood flow score and DAS28 score was the highest(r=0.782);The joint effusion score was positively correlated with DAS28,TJC,and ESR(r=0.369,0.369,0.257).(5)The correlation analysis results of NLR,PLR and other indicators show that,There was a positive correlation between the two and the the total ultrasound score and synovial hyperplasia score,synovial blood flow score,bone erosion score,DAS28 score,TJC,SJC,ESR,and CRP(r=0.414,0.376,0.407,0.282,0.496,0.379,0.282,0.468,0.404;0.346,0.378,0.436,0.296,0.506,0.458,0.247,0.400,0.338).(6)The sensitivity of ultrasound evaluation using the Szkudlarek level 4 semi quantitative score to detect active synovitis was higher than that of clinical evaluation using the DAS28 score(P<0.001).(7)According to the correlation analysis results between ultrasound scores of each joint and DAS28 score,ESR,CRP of each joint,In this study,8 joints with high correlation coefficient were selected as SUSS,including bilateral Wri,MCP2,MCP3,and PIP3.The system used only 8 joints and 22 joints for Szkudlarek level 4 semi quantitative score comparison,and the two were highly correlated(r=0.931,P<0.001),The detection rate of synovial blood flow signals is highly consistent.(8)Draw ROC curves for SUSS,NLR,PLR,and SUSS+NLR,SUSS+PLR,and SUSS+NLR+PLR to evaluate activity of rheumatoid arthritis disease,The sensitivity,specificity,and AUC were 64.6%,87.5%,62.5%,66.7%,62.5%,64.6%;85.7%,54.8%,85.7%,88.1%,85.7%,92.9%;0.813,0.763,0.769,0.842,0.859,0.865,The results showed that SUSS+NLR+PLR had the highest specificity,with a statistically significant difference in AUC compared to SUSS alone(0.865 vs 0.813,P<0.01).Conclusion: SUSS consisting of 8 joints including bilateral Wri,MCP2,MCP3,and PIP3 was analyzed with using 22 joints,The two are highly correlated and maintain a high degree of consistency in the detection of active synovitis,This indicates that SUSS has the advantage of reducing the number of joint examinations and reducing the examination time.SUSS+NLR+PLR can improve the specificity of activity of rheumatoid arthritis disease evaluation,which is conducive to more accurate clinical understanding of the condition of RA patients.