Evaluation of inflammatory biomarkers and the ratio of hemoglobin-red cell distribution width in patients with rheumatoid arthritis treated with tumor necrosis factor-alpha inhibitors

• Published in: Clinical rheumatology Vol. 43; no. 6; pp. 1815 - 1821
• Main Authors: Yetişir, Ayşegül, Sariyildiz, Aylin, Türk, İpek, Coskun Benlidayi, Ilke
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-06-2024; Springer Nature B.V
• Subjects: Adult; Aged; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - blood; Arthritis, Rheumatoid - drug therapy; Biomarkers; Biomarkers - blood; Erythrocyte Indices; Female; Hemoglobin; Hemoglobins - analysis; Humans; Inflammation; Leukocytes (neutrophilic); Lymphocytes; Male; Medicine; Medicine & Public Health; Middle Aged; Monocytes; Neutrophils; Original Article; Remission; Retrospective Studies; Rheumatoid arthritis; Rheumatology; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor necrosis factor-TNF; Tumor necrosis factor-α; Biomarkers; Red cell distribution width; Tumor necrosis factor inhibitors; Rheumatoid arthritis; Hemoglobins
• ISSN: 0770-3198; 1434-9949; 1434-9949
• DOI: 10.1007/s10067-024-06963-y

Background
The aim of this study was to examine pre-treatment and post-treatment hemogram-derived inflammatory biomarkers in patients with rheumatoid arthritis (RA) who received anti-tumor necrosis factor (TNF)-α treatment.
Material and methods
The data of 1182 patients with RA were screened. Among them, 207 patients who met the eligibility criteria were included in the retrospective study. Demographic parameters, disease activity, and blood cell-derived indexes were evaluated. The neutrophil–lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), and hemoglobin-red cell distribution width (Hb/RDW) rates were evaluated before treatment and at the third month of treatment in patients with RA who received anti-TNF-α treatment.
Results
According to the EULAR response criteria, 12.6% of the 207 patients responded to anti-TNF-α treatment as none, 21.3% as good, and 66.2% as moderate, respectively. Post-treatment NLR and PLR values were significantly lower than pre-treatment values (
p
 < 0.001), whereas post-treatment LMR and Hb/RDW values were significantly higher than pre-treatment values (respectively,
p
 = 0.001 and
p
 = 0.012). The difference between pre-treatment and post-treatment values of LMR and Hb/RDW was significantly higher when compared to the moderate + good response groups than the none-response group (
p
 = 0.002 and
p
 = 0.014, respectively). However, in the receiver operating characteristic curve analysis, these parameters were not found to be significant in predicting treatment response.
Conclusion
Significant changes were detected in hemogram-derived inflammatory markers of the groups responding to anti-TNF-α treatment. They can be used as a guide during treatment follow-up. Yet, they do not predict treatment response.
Key Points
• RA may manifest with periods of remission and activation, and regular follow-up is essential.
• There is a demand for readily available, reproducible, and cost-effective parameters to assess treatment response.
• Hemogram-derived inflammatory markers differ in relation to anti-TNF-α treatment response in RA.
• None of those markers demonstrate an acceptable predictive performance in distinguishing patients based on their response to TNF-α inhibitors.