Correlation between neutrophil to lymphocyte ratio and disease activity in patients with rheumatoid arthritis.


  • Huma Liaqat Fauji Foundation Hospital Rawalpindi.
  • Muhammad Salman Aamir Hayatabad Medical Complex, Peshawar.
  • Shahida Perveen Fauji Foundation Hospital, Rawalpindi.
  • Saba Samreen Fauji Foundation Hospital, Rawalpindi.
  • Haris Gul Fauji Foundation Hospital, Rawalpindi.
  • Babur Salim Fauji Foundation Hospital, Rawalpindi.



Clinical Disease Activity Index CDAI, Disease Activity Score-28 DAS-28, Neutrophils to Lymphocytes Ratio NLR, Rheumatoid Arthritis RA, Simplified Disease Activity Index SDAI


Objective: To figure out correlation between neutrophils to lymphocyte ratio in rheumatoid arthritis and its relationship with the disease severity. Study Design: Prospective study. Setting: Department of Rheumatology Fauji Foundation Hospital, Rawalpindi, Pakistan. Period: July 1st to December 31st, 2021. Material & Methods: Study population included rheumatoid arthritis patients fulfilling American college for rheumatology criteria. On the basis of disease activity score-28 (DAS-28), the subjects were categorised into active and remission groups. The control group consisted of healthy age and gender matched subjects. Relationship between neutrophils to lymphocytes ratio with disease activity was analyzed. Data was analysed using SPSS 21. Results: 140 patients with RA were evaluated along with 70 healthy control subjects. NLR was higher in active RA (1.99±0.84) as compared to RA with remission (1.76±0.41) and controls (1.77±0.79). p value<0.05 was obtained which was statistically significant. NLR is significantly correlated with CDAI and SDAI (r=0.24, p=0.04 each). CRP and ESR were also significantly higher in active RA patients compared to those in remission (p<0.005 and p<0.00 respectively) and control group. Conclusion: The neutrophil to lymphocyte ratio is a measure derived from a simple blood test. An elevated NLR is often considered an indicator of systemic inflammation. High NLR values may suggest increased inflammation and immune system activation, which are key features of RA. NLR may serve as a less expensive and easily accessible marker to detect inflammation in RA. It can be utilized in future as disease assessment tool.

Author Biographies

Huma Liaqat, Fauji Foundation Hospital Rawalpindi.

FCPS (Medicine), FCPS (Rheumatology), MRCP (Medicine), Rheumatologist, Rheumatology, 

Muhammad Salman Aamir, Hayatabad Medical Complex, Peshawar.

FCPS (Medicine), Fellow Endocrinology Diabetes, 

Shahida Perveen, Fauji Foundation Hospital, Rawalpindi.

FCPS (Medicine), FCPS (Rheumatology), Professor Rheumatology, 

Saba Samreen, Fauji Foundation Hospital, Rawalpindi.

FCPS (Medicine), FCPS (Rheumatology), Assistant Professor Rheumatology, 

Haris Gul, Fauji Foundation Hospital, Rawalpindi.

FCPS (Medicine), FCPS (Rheumatology), Assistant Professor Rheumatology, 

Babur Salim, Fauji Foundation Hospital, Rawalpindi.

FCPS (Medicine), FCPS (Rheumatology), Associate Professor Rheumatology,