J Rheum Dis 2018; 25(3): 169-178  
Association between the Neutrophil-to-lymphocyte Ratio, and Platelet-to-lymphocyte Ratio and Rheumatoid Arthritis and their Correlations with the Disease Activity: A Meta-analysis
Young Ho Lee
Division of Rheumatology, Department of Internal Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Korea
Correspondence to: Young Ho Lee, http://orcid.org/0000-0003-4213-1909
Division of Rheumatology, Department of Internal Medicine, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea. E-mail:lyhcgh@korea.ac.kr
Received: October 12, 2017; Revised: March 11, 2018; Accepted: March 14, 2018; Published online: July 1, 2018.
© Korean College of Rheumatology. All rights reserved.

This is a open Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective. This study examined the relationship between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and rheumatoid arthritis (RA), to establish a correlation among the NLR, PLR, and MPV and RA activity. Methods. Medline, Embase, and Cochrane were searched, and a meta-analysis was performed to compare the NLR, PLR, and MPV between RA patients and healthy controls. The correlation coefficients between NLR, PLR, and MPV and the Disease Activity Score 28 (DAS28) in the RA patients were examined. Results. Sixteen studies were included in this meta-analysis. NLR was significantly higher in the RA group (standardized mean difference [SMD], 0.800; 95% confidence interval [CI], 0.542∼1.058; p<0.001). Stratification according to ethnicity revealed a significantly elevated NLR in the RA group in Asian and Turkish populations (SMD, 95% CI: 0.994, 0.418∼1.519, p=0.001 and 0.695, 0.443∼0.948, p<0.001, respectively). Subgroup analysis revealed a significantly high NLR in RA, independent of the data type and adjustment for age and/or sex. PLR was also significantly higher in the RA group (SMD, 0.708; 95% CI, 0.401∼0.995; p<0.001), regardless of ethnicity, data type, and adjustment for age and/or sex. In addition, NLR and PLR were positively associated with the RA activity based on the DAS28 (correlation coefficient, 95% CI: 0.277, 0.190∼0.359, p<0.001 and 0.318, 0.197∼0.430, p<0.001, respectively). However, MPV showed no correlation with the RA activity (correlation coefficient, −0.095; 95% CI, −0.435 to 0.269; p=0.615). Conclusion. Meta-analysis showed that the NLR and PLR were significantly higher in the RA patients and positively but weakly correlated with the RA activity.
Keywords: Neutrophil-to-lymphocyte ratio, Platelet-to-lymphocyte ratio, Mean platelet volume, Rheumatoid arthritis


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