Akademik Veri Yönetim Sistemi
EULAR 2023, Milan, İtalya, 31 Mayıs - 03 Haziran 2023, ss.1300
Background: The most commonly used disease activity index in rheumatoid arthritis (RA) is Disease Activity Score 28 (DAS28). However, the need for objective disease activity indices retains. The nutritional and inflammatory indices were recently evaluated in many rheumatologic and non-rheumatic conditions as predictors of disease activity. Objectives: We aimed to evaluate the association of six different nutritional and inflammatory indices with disease activity and patient reported outcomes (PROs) in patients with RA. Methods: In this cross-sectional study, we recruited RA patients who fulfilled the 2010 ACR/EULAR classification criteria. Participants’ demographic features, disease duration, current medication, disease activity indices [DAS28 with erythrocyte sedimentation rate (DAS28-ESR), simplified disease activity index (SDAI), linical disease activity index (CDAI)], PROs [Health Assessment Questionnaire-Disability Index (HAQ-DI), Rheumatoid arthritis Impact of Disease (RAID)], Multimorbidity Index (MMI), hand and foot erosions, deformities, extra-articular manifestations of RA, nutritional and inflammatory status [prognostic nutritional index (PNI), controlling nutritional status (CONUT) score, neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), systemic inflammation response index (SIRI), Mini Nutritional Assessment-Short Form (MNA-SF), body mass index (BMI), waist and hip circumference] were noted. Patients were divided into 2 groups (remission and low disease activity vs. moderate and high disease activity) according to their DAS28-ESR scores. Results: A total of 183 RA patients were analyzed. The mean age was 29.5±5.7 years, the median time of disease duration was 120 (60-238) months, 83.1% (n=152) were female, 69.9% were RF positive (n=128), 59% (n=108) were antiCCP positive, 79.1% (n=145) were on conventional synthetic disease-modifying antirheumatic drugs (csDMARD), 5.5% (n=10) used targeted synthetic DMARD (tsDMARD), 16.4% (n=30) were used biologic DMARD (bDMARD). Median PNI values were lower in patients with extra-articular involvement (p<0.001). Mean PNI values were lower in patients with hematologic involvement, anemia, and thrombocytopenia (p<0.001, p=0.026, p=0.033), those with erosion on the foot X-ray (p=0.005), and CCP positive ones (p=0.028). NLR and SIRI were positively correlated with physician’s global assessment (PGA) score (r=0.270, p<0.001; r=0.227, p=0.002), SDAI (r=0.219, p=0.003; r=0.199, p=0.007), CDAI (r=0.192, p=0.009; r=0.154, p=0.037), DAS28-ESH (r=0.232, p=0.002; r=0.186, p=0.012), ESR (r=0.233, p=0.001; r=0.218, p=0.003) and c-reactive protein (r=0.324, p<0.001; r=0.380, p<0.001). MNA-SF was negatively correlated with HAQ-DI (r=-0.199, p=0.007), RAID (r=-0.179, p=0.015), PGA score (r=-0.280, p<0.001), SDAI (r=-0.205, p=0.005), CDAI (r=-0.224, p=0.002), and DAS28-ESH (r=-0.186, p=0.012). PNI was not correlated with disease activity scores and PROs. Conclusion: In this study where we aimed to determine the role of a variety of nutritional inflammatory indices in disease activity ascertainment of RA patients, while NLR, MNA-SF, and SIRI had significant associations with other composite disease activity indices, PNI failed to establish such a relationship. However, PNI was significantly higher in CCP-positive RA patients and ones with extraarticular involvement. Prospective longitudinal studies on larger samples are needed to elucidate the role of nutritional inflammatory indices in determining RA disease activity.
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