Clinical Significance Of Blood Routine Index In Rheumatoid Arthritis And Ankylosing Spondylitis

Background:Rheumatic diseases are a type of disease that mainly affects bones,joints and muscles,and can also involve blood,nerves,and other systems.The causes of rheumatic diseases include immunity,metabolism,degeneration,etc.Common rheumatic diseases include ankylosing spondylitis(AS),rheumatoid arthritis(RA),etc.Early diagnosis and disease assessment of RA and AS are crucial for clinical decision-making.Currently,the commonly used indicators of disease activity evaluation include subjective scores and objective test indicators.C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)are commonly used objective indicators of disease activities,but their sensitivity is not good when the disease activity is low.Therefore,it is of great significance to further explore the biomarkers for the diagnosis and assessment of rheumatic diseases.Immune cells play a very important role in the development of rheumatic diseases,such as neutrophils,lymphocytes,platelets and neutrophil to lymphocyte ratio(NLR),platelet to lymphocytes ratio(PLR)is considered to be important markers of systemic inflammation.Studies have shown that mean platelet volume(MPV)is a marker for monitoring the activity of axial-axis spondyloarthritis(axSpA)disease,and NLR and PLR are biomarkers for assessing the activity of RA and Behcet's disease.However,the blood routine index is still controversial for the diagnosis of rheumatic diseases and the significance of disease activity assessment.Objective:1.To explore the value of blood routine index in the diagnosis of RA and its relationship with disease activity,and to observe the changes of blood routine index of RA patients after Tumor necrosis factor inhibitors(TNFi)treatment.2.To explore the value of blood routine index in the diagnosis of AS and its relationship with disease activity,and to observe the changes of blood routine index of AS patients after TNFi treatment.Methods:This study was a retrospective analysis.RA and AS patients admitted to the rheumatology and immunology department of the Guangdong Second Provincial General Hospital from January 2016 to January 2019 were selected research objects.The control group was randomly enrolled by SPSS software in the physical examination population of a unit,and there was no significant difference in age and gender,clinical features,neutrophil count,platelet count,CRP,ESR,etc.of RA and AS patients were collected,and calculated MLR,PLR,NLR,28 joint disease activity(DAS28)score,ankylosing spondylitis disease activity index(BASDAI)score.The blood routine indexes of each group were compared with those of the control group.The continuous variables were expressed by median and quartile,the differences between the groups were compared by non-parametric test,and the gender composition between the two groups was different or not by chi-square test,The Spearman correlation coefficient was used to evaluate the linear relationship between the variables.The area under the curve(AUC),optimal cutoff,sensitivity,and specificity were calculated using the receiver work(ROC)curve.Results:1.The levels of neutrophils count,monocytes count,platelet count,PCT,NLR,PLR and MLR in peripheral blood of RA patients were significantly increased,while lymphocyte count and PDW were lower than those in control(P<0.05).When the ROC curve was used to evaluate the diagnostic value of each study index for RA,the AUC values of PDW and MLR were higher,and the AUC value of PDW was 0.953(CI95%:0.924-0.982),the optimal cutoff value was 15.35,with the specificity was 92.1%,the sensitivity is 93.7%.Spearman analysis showed that platelet count,PCT,PDW and PLR were correlated with ESR,CRP and DAS28 score.After 1 month of TNFi treatment,the levels of neutrophils count,platelet count,monocytes count,PCT,NLR,and PLR in peripheral blood of RA patients were significantly lower than before(P<0.05).2.The levels of neutrophils count,monocytes count,platelet count,PCT,NLR,PLR and MLR in peripheral blood of AS patients were significantly increased,while lymphocyte and PDW were lower than those in control(P<0.05).When the ROC curve was used to evaluate the diagnostic value of each study index for AS,the AUC value of PDW was the highest,the AUC value was 0.860(CI95%:0.817-0.904),the optimal cutoff value was 0.15,and the specificity was 81.2%,The sensitivity is 87.5%.Spearman analysis showed that platelet count and PCT were correlated with ESR,CRP and BASDAI scores.After 1 month of TNFi treatment,the peripheral blood neutrophils count,platelet count,PCT,NLR,MLR and PLR levels were significantly lower than before,and PDW levels were increased(P<0.05).Conclusions:1.In the RA group,the ROC curve results showed that the AUC values of PDW and MLR were higher than other blood routine indexes,suggesting that PDW and MLR had higher diagnostic value;Platelet count,PCT,PDW and PLR were correlated with ESR,CRP and DAS28,indicating that platelet count,PCT,PDW and PLR could be used to evaluate the disease activity of RA.2.In the AS group,the ROC curve showed that the AUC value of PDW was higher than that of other blood routine indexes,suggesting that PDW had higher diagnostic value.Platelet count and PCT were correlated with ESR,CRP and BASDAI,indicating that platelet count and PCT could be used to evaluate the disease activity of AS.