Metabolic Syndrome and Rheumatoid Arthritis Activity: An Analysis of Clinical, Laboratory, and Ultrasound Parameters.

(1) Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease associated with an increased incidence of metabolic syndrome (MetS). The aim of this study was to determine if there is an association between MetS and parameters of RA activity, as well as between metabolic parameters and indices of RA activity. (2) Methods: This study involved 65 patients with RA. MetS was diagnosed according to the 2009 IDF/AHA/NHLBI criteria. The comparative analysis was conducted between RA patients with MetS (RA (MetS (+)) and without MetS (RA (MetS (-)). The activity of RA was assessed using clinical, laboratory, and ultrasound (US) parameters. (3) Results: Compared with RA MetS (-) patients, RA MetS (+) patients were characterized by higher disease activity, according to Disease Activity Score (DAS28), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI). RA MetS (+) patients had significantly higher tender and swollen joint counts, and values of erythrocyte sedimentation rate, C-reactive protein, and US parameters (grey-scale (GSUS), power Doppler (PDUS)). Significant correlations were found between metabolic parameters (waist circumference, cholesterol and glucose concentrations) and indices of RA activity. (4) Conclusion: The results of this study show that, in patients with RA, the presence of MetS is associated with higher disease activity, based on several clinical, laboratory, and US parameters.

The Usefulness of Cellular Immune Inflammation Markers and Ultrasound Evaluation in the Assessment of Disease Activity in Patients with Spondyloarthritis.

BACKGROUND: The systemic inflammation response index (SIRI) and systemic immune-inflammation index (SII) have been introduced as inflammatory markers and predictors of poor prognosis in cancer and cardiovascular diseases. An appropriate evaluation of disease activity in spondyloarthritis (SpA) might be challenging. The purpose of this study was to evaluate the usefulness of cellular immune inflammation markers and ultrasound (US) evaluation of entheses and joints in the assessment of disease activity in SpA patients. METHODS: This cross-sectional study involved patients with SpA (62 axial SpA, 38 peripheral SpA, pSpA). The clinical data of both tender, swollen joint counts, erythrocyte sedimentation rate, C-reactive protein, white blood cell counts, and disease activity using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Disease Activity Index for Psoriatic Arthritis (DAPSA), were recorded. The SIRI, SII, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were calculated. US examination was performed (22 small joints, Achilles tendon, and plantar aponeurosis for enthesitis). RESULTS: The SII, SIRI, NLR, and PLR were higher, and LMR was lower in patients with high disease activity (BASDAI > 4). Higher SII was observed in pSpA patients with moderate/high disease activity (DAPSA > 14). The SIRI was correlated with clinical and laboratory parameters of disease activity. The SII was correlated with US parameters in pSpA. Higher SII and NLR values were found in patients with signs of activity compared with no activity in the US of peripheral joints. There were no associations with US changes in entheses. CONCLUSIONS: The results of this study point to the value of SIRI and SII as biomarkers of disease activity in patients with SpA. The SII was associated with synovitis in the US of the peripheral joints.

Adiponectin and Leptin as Biomarkers of Disease Activity and Metabolic Disorders in Rheumatoid Arthritis Patients.

Background: Rheumatoid arthritis (RA) is an autoimmune disease, characterized by inflammation of multiple joints, resulting in irreversible cartilage and bone destruction. Chronic disease activity may be associated with metabolic disorders and premature atherosclerosis. Adipokines are involved not only in metabolism regulation, but also in inflammatory and immune response. Aim: This study is designed to explore relationships between adipokines (adiponectin, leptin) and metabolic parameters, as well as disease activity, in patients with chronic RA. Methods: This cross-sectional study enrolled 109 patients with RA. The clinical assessment was performed including tender and swollen joint counts, Disease Activity Score 28 (DAS28), body mass index (BMI). The following laboratory parameters were performed: erythrocyte sedimentation rate, C-reactive protein, glucose, lipid profile, creatinine. Serum levels of adiponectin and leptin were assessed by enzyme-linked immunosorbent assay (ELISA). Results: The mean adiponectin and leptin serum concentrations remained within normal ranges. Both, adiponectin and leptin levels were not associated with current disease activity markers (clinical and laboratory), and type of treatment. Significant relationships were found between adipokines and metabolic parameters, as well as with coexistent conditions and RA characteristics. Higher leptin levels were noticed in patients with hypertension. In the multiple linear regression analysis, correlations were confirmed. Adiponectin was positively correlated with HDL-C (b = 0.37, p < 0.001), age (b = 0.39, p< 0.001), and negatively with glucose (b = -0.17, p = 0.03). Leptin was positively correlated with BMI (b = 0.58, p < 0.001), and negatively with estimated glomerular filtration rate (eGFR) (b = -0.30, p < 0.001). Conclusion: The results of this study show the value of adipokines as indicators of metabolic disorders, rather than inflammatory markers in patients with chronic RA, treated with immunosuppressive or biological drugs. High leptin level may indicate poor prognostic factors, kidney and cardiovascular complications. Adiponectin seems to be protective against metabolic disorders in chronic RA.

The Relationship between Platelet Indices and Ultrasound, Clinical, Laboratory Parameters of Disease Activity in Patients with Rheumatoid Arthritis.

(1) Background: A proper assessment of disease activity is crucial for the management of a patient with rheumatoid arthritis (RA). Platelets seem to be involved in joint inflammation pathophysiology. Platelet indices (PIs) are markers of platelet activation, and include platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT). The purpose of the study was to assess the relationship between PIs and disease activity markers, both systemic (clinical, laboratory) and local (ultrasound, US), in patients with RA; (2) Methods: The study group consisted of 131 consecutive RA patients. The following assessments were performed: joint counts, Disease Activity Score (DAS28), complete blood cell counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and US of 24 small joints; (3) Results: Mean values of PIs remained within the normal reference ranges. Values of PC, PCT, PDW were significantly associated with disease activity markers, both clinical (DAS28, joint counts) and laboratory (CRP, ESR). In patients with high disease activity, PC, PCT were significantly higher and PDW lower. PC was positively correlated with Power Doppler US (PDUS) score. In patients with features of RA severity (antibodies positivity, extra-articular manifestations) PC and PCT were positively associated with all US parameters (Grey Scale US, PDUS, Global scores); (4) Conclusions: In patients with RA, PC and PCT may serve as positive disease activity markers and PDW may serve as a negative marker. PIs may be used as reliable, inexpensive markers of RA systemic activity; they may also serve as markers of local inflammation in the joints affected by RA.

Systemic Inflammatory Parameters in Patients with Elderly-Onset Rheumatoid Arthritis (EORA) and Young-Onset Rheumatoid Arthritis (YORA)-An Observational Study.

BACKGROUND: Rheumatoid arthritis (RA) occurs more often in elderly individuals. Elderly onset RA (EORA) (onset > 60 years) encompasses a specific subset of patients if compared with young onset RA (YORA) (onset at a younger age). There is a need to define reliable, simple markers to properly assess the inflammatory activity of RA. Hematological markers of systemic inflammation (Platelet-To-Lymphocyte (PLR) and Neutrophil-To-Lymphocyte (NLR) ratios) are novel measures of the inflammatory response. The goal of the study was to analyze the course of EORA vs. YORA patients and to assess associations between systemic and clinical disease activity markers, including PLR and NLR, in different subsets of patients. PLR and NLR have not previously been assessed in EORA and YORA. METHODS: The study group consisted of 113 consecutive patients (63 EORA and 50 YORA). The following assessments were performed: joint counts, Disease Activity Score (DAS28), complete blood cell counts, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). RESULTS: EORA was characterized by significantly higher disease activity markers (conventional inflammatory and clinical), a lower rate of remission or low disease activity, and less frequent use of biological drugs and glucocorticoids. The NLR and PLR were positively correlated with disease activity markers. The PLR was significantly lower in EORA compared with in YORA. CONCLUSION: EORA and YORA patients differed significantly. In EORA, conventional disease activity markers were higher, the PLR was significantly lower.

The Relationship between Hematological Markers of Systemic Inflammation (Neutrophil-To-Lymphocyte, Platelet-To-Lymphocyte, Lymphocyte-To-Monocyte Ratios) and Ultrasound Disease Activity Parameters in Patients with Rheumatoid Arthritis.

BACKGROUND: An accurate measurement of disease activity is essential for the appropriate management of a patient with rheumatoid arthritis (RA). Hematological markers of systemic inflammation (Neutrophil-to-Lymphocyte (NLR), Platelet-to-Lymphocyte (PLR) and Lymphocyte-to-Monocyte (LMR) ratios) are reported to be novel, sensitive measures of inflammatory response, in addition to conventional markers (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Disease Activity Score (DAS28)). The goal of the study was to assess the relationship of NLR, PLR, and LMR with ultrasonography (US) parameters of disease activity in RA patients. METHODS: The study group consisted of 126 consecutive RA patients (100 women, 26 men). The following assessments were performed: joint counts, DAS28, complete blood cell counts, ESR, CRP, and US of 24 small joints. RESULTS: NLR and PLR were significantly positively correlated with all US parameters of disease activity (Grey Scale US, Power Doppler US, and Global scores). The mean values of NLR and PLR were significantly higher in patients with poor prognostic factors: moderate/high vs. low disease activity (NLR: p < 0.001; PLR: p = 0.007), anti-CCP positive vs. anti-CCP negative (NLR: p = 0.01; PLR: p = 0.006). In multiple regression tests, significant correlations were confirmed for: NLR and DAS28 (p = 0.04), and CRP (p = 0.001); PLR and Power Doppler US (p = 0.04), and ESR (p = 0.02). No correlation was found for LMR. CONCLUSION: NLR and PLR are associated with US disease activity parameters and may serve as reliable, inexpensive markers, with prognostic significance in RA.