Emerging Value of Platelet-to-Hemoglobin Ratio and Monocyte-to-Hemoglobin Ratio in Assessment of Rheumatoid Arthritis Patients

Abstract

Abstract Background: Rheumatoid arthritis (RA) is chronic au-toimmune disease associated with systemic inflammation that affects mainly synovial joints. Inflammation is the main reason of tissue destruction, physical disability and excess of mortality in RA. There is a need to find accurate inexpensive valuable inflammatory markers to be helpful in early diagnosis, prompt treatment and strict follow-up of RA patients. Aim of Study: To assess platelet-to-hemoglobin ratio (PHR) and monocyte-to-hemoglobin ratio (MHR) in RA patients. In addition to evaluate their associations with clinical and laboratory markers of RA disease activity and severity. Patients and Methods: The study included 175 adult RA patients and 186 age and gender healthy individuals were enrolled as control group. Disease activity score (DAS28) and RA medical records-based index of severity (RARBIS) were assessed in RA patients. PHR and MHR were measured in patients and controls. Results: They were 154 females and 21 males RA patients with a mean age of 45.43±10.5 years and disease duration of 9.3±0.47 years. PHR and MHR were significantly higher in patients (27.04±9.52, 0.03±0.02) than controls (21.58±5.6, 0.02±0.01) respectively, (p < 0.001). PHR and MHR had diag-nostic ability to discriminate RA patients from controls with sensitivity of 75%, 73.94% respectively and specificity of 53.23% in both. PHR had significant positive correlations with DAS28 (r=0.25, p=0.003), RARBIS (r=0.20, p=0.041), erythrocyte sedimentation rate (ESR) (r=0.41, p < 0.001), C-reactive protein (CRP) (r=0.4, p < 0.001) and anti-cyclic cit-rullinated peptide antibodies (anti-CCP abs) (r=0.3, p=0.001). MHR was only correlated with CRP (r=0.24, p=0.002). Mul-tivariate linear regression for the increase in PHR among RA patients revealed that ESR (b=0.100; p < 0.001, CI=0.05-0.145) and CRP (b=0.091; p=0.004, CI=0.02-0.152) were significant predictors. Conclusion: PHR and MHR were significantly increased in RA patients than controls. In addition, PHR and to lesser extent MHR were associated with RA disease activity and severity clinical as well as laboratory markers. This means they may serve as novel, inexpensive and easily obtainable inflammatory RA markers helping in evaluation and monitoring of RA patients disease activity and severity.