Novel Hematological Markers Neutrophil to Hemoglobin Lymphocytes Ratio and Platelets to Lymphocytes Ratio and its Association with the Disease Activity in Rheumatoid Arthritis

Heamtological Markers in Rheumatoid Arthritis


  • Taqdees Khaliq Head of Rheumatology Unit, Federal Government Polyclinic Hospital Islamabad, Pakistan
  • Sarah Azam Shah Federal Government Polyclinic Hospital Islamabad, Pakistan
  • Khadija Iftikhar Hematologist, Federal Government Polyclinic Hospital Islamabad, Pakistan


Rheumatoid Arthritis (RA), Neutrophil to Hemoglobin and Lymphocyte Ratio (NHL), Platelet to Lymphocyte Ratio (PLR), Disease Activity score ESR (DAS28-ESR)



Objective: This study was done to find out the role of two new markers Neutrophil to Hemoglobin and Lymphocytes ratio (NHL) and the Platelet Lymphocytes ratio (PLR) in ascertaining the activity of disease in rheumatoid arthritis. Design: A retrospective cross sectional study.

Place and Duration: The study was carried out on 290 patients in the Rheumatology outpatient department of Federal Government Polyclinic Hospital, Islamabad. The data under study was taken from Dec 2020 till June 2021.

Methodology: DAS28-ESR was calculated using the DAS28-ESR calculator and NHL & PLR were calculated.

Results: There were 238(82.1%) female and 52 (17.9%) male participants. The mean age of patients was 45.2± 12 years. Out of the 290 participants, 22.8% had inactive disease (<3.2 DAS28 score) while 77.2% had active disease (>3.2 DAS 28ESR). The spearman's rho analysis found a significant positive correlation between the disease activity score and the NHL and PLR (p<0.001). The receiver operating curves (ROC) for the NHL was 0.736 (95% Confidence Interval (CI):666–0.807, p < 0.001) , 0.672(95% CI:0.597-0.747, p < 0.001) for PLR and 0.756(95% CI: 0.687-0.824, p < 0.001) for ESR respectively.

Conclusion: Both NHL ratio and PLR can be used as a cheap and easily measurable tool for disease severity assessment in rheumatoid arthritis patients.






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