CRP-albumin ratio, neutrophil-lymphocyte ratio predict persistent JIA disease activity
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Key takeaways:
- At baseline, patients with JIA had higher C-reactive protein and CRP-to-albumin ratio vs. controls.
- C-reactive protein-to-albumin ratio and neutrophil-to-lymphocyte ratio predicted disease activity risk at 6 months.
It may be possible to forecast persistent disease activity in juvenile idiopathic arthritis using C-reactive protein-to-albumin ratio and neutrophil-to-lymphocyte ratio, according to data published in BMC Rheumatology.
“The identification of new biomarkers, which correlate with clinical and subclinical disease activity, is an important goal for children with JIA and an open field of scientific research,” Giulia Di Donato, of the pediatric rheumatology department at the S.S. Annunziata Hospital, in Chieti, Italy, and colleagues wrote. “The incorporation of reliable standardized biomarkers in clinical care may allow the clinicians to better design patient-tailored treatment regimens, and it may help to choose the optimal modalities and timing for treatment discontinuation.”
To determine whether biomarkers established in other rheumatic diseases — namely, C-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) — have value in measuring JIA disease activity, Di Donato and colleagues conducted a prospective, cross-sectional study. Participants included patients with JIA who were referred to the rheumatology unit at University of Chieti from December 2019 to June 2022.
The analysis included 130 patients with non-systemic JIA (mean age, 11 years), 74 of whom demonstrated active disease while 56 had inactive disease, as well as 62 healthy control patients (mean age, 10 years). At 3 months, 6 months, 12 months and 18 months from baseline, the researchers analyzed blood samples for biomarkers and noted disease activity using the Juvenile Arthritis Disease Activity Score (JADAS-27). A generalized estimating equation model, applied to all patients with active or inactive disease, was also used to longitudinally assess links between disease activity and CAR, PLR and NLR ratios.
The analysis revealed “no positive correlation” between JADAS-27 score and CAR, NLR or PLR among patients with JIA, according to the researchers. However, at baseline, patients with JIA demonstrated higher C-reactive protein and CAR than controls (P = .046).
Meanwhile, the generalized estimating equation model found that CAR and NLR levels at baseline predicted higher risk for disease activity at the 6-month follow-up visit (P < .001).
“In our work, CAR was significantly increased in JIA patients as compared to healthy subjects, without a clear correlation with disease activity scores,” Di Donato and colleagues wrote. “Moreover, according to our predictive model, basal CAR and NLR could effectively predict persistent disease activity at 6 months follow up, thus influencing clinician’s decisions about treatment discontinuation or tapering. However, significant cut-off values have not been identified and the role of these indices in the long term follow up has still to be established.
“Further prospective studies with a larger and more homogeneous sample and with a complete follow-up should be carried out to better clarify the role of CAR, PLR and NLR in the evaluation of disease activity in JIA,” they added. “Finally, their evaluation in patients with [systemic JIA] could be of great interest, given its peculiar inflammatory pathogenesis.”
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