RESUMO
BACKGROUND: Although normal acute phase reactants (APRs) play an important role in assessing disease activity of rheumatoid arthritis (RA), some studies pointed out the discordance between disease activity and APR level. Neutrophil-to-lymphocyte ratios (NLRs), platelet-to-lymphocyte ratios (PLRs) and lymphocyte-to-monocyte ratios (LMRs) have been reported to be sensitive measures of inflammatory reaction. This study aims to explore the value of these haematological makers in assessment of APR-negative RA patients. METHODS: Out of a cohort of 418 consecutive patients with RA, we enrolled 135 patients with normal APR for this study. We performed ultrasound assessments to evaluate synovitis and bone erosion in the affected joints. Synovitis was evaluated by ultrasound grey scale (GS) and power Doppler (PD) with semi-quantitative scoring (0-3). Demographic, clinical and laboratory data were collected from the patients. Disease Activity Score-28 joints (DAS28), NLR, MLR and PLR were calculated. RESULTS: In RA patients with normal APR, PLR exhibited a positive correlation with ultrasound-detected synovitis and bone erosion, whereas NLR, MLR showed no significant correlation with ultrasonography parameters. The area under the ROC curve (AUC) for identifying synovitis with a GS grade ≥2 based on a PLR cutoff value of ≥159.6 was 0.7868 (sensitivity: 80.95%, specificity: 74.24%). For synovitis with a PD grade ≥2, the AUC was 0.7690, using a PLR cutoff value of ≥166.1 (sensitivity: 68.0%, specificity: 83.87%). CONCLUSIONS: Our findings suggested that PLR might be a reliable and cost-effective marker for identifying moderate-to-severe synovitis in RA patients with normal APR.
Assuntos
Artrite Reumatoide , Biomarcadores , Linfócitos , Sinovite , Humanos , Sinovite/diagnóstico por imagem , Sinovite/sangue , Sinovite/diagnóstico , Artrite Reumatoide/sangue , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/complicações , Feminino , Masculino , Pessoa de Meia-Idade , Biomarcadores/sangue , Adulto , Plaquetas , Proteínas de Fase Aguda/análise , Idoso , Índice de Gravidade de Doença , Contagem de Plaquetas , Curva ROC , Contagem de Linfócitos , NeutrófilosRESUMO
Se presentan las historias clinicas de 2 casos que llenan los requisitos del sindrome de sinovitis simetrica seronegativa remitente con edema blando(RS 3 PE), recientemente descrito por McCarty. Son los primeros casos de este sindrome que se publican en Colombia. Se revisan las caracteristicas clinicas, de laboratorio y de rayos X. Al tratamiento aceptado con antiinflamatorios no esteroideos y cloroquina, se sugiere agregar 7.5 mg/dia de prednisolona en dosis fraccionadas. Este tratamiento se prescibio en los casos presentados y se observo que acorta la evolucion de la enfermedad y produce alivio sintomatico rapido con efectos colaterales escasos leves.