Skip to main content
Egyptian Rheumatology and Rehabilitation
Download PDF
  • Original article
  • Open access
  • Published:

Neutrophil-to-lymphocyte ratio: relation to disease activity and carotid intima-media thickness in Behçet’s disease

Egyptian Rheumatology and Rehabilitation volume 45, pages 133–139 (2018)Cite this article

Abstract

Background

Behçet’s disease (BD) is an autoinflammatory disorder. Disease activity could be detected by changes in peripheral blood cell components. The aim of this study was to assess the relationship between neutrophil-to-lymphocyte ratio (NLR) with disease activity and carotid intima-media thickness (cIMT) in patients with BD.

Patients and methods

This study was conducted on 20 adult patients with BD (group I). This group was subdivided according to cIMT into group Ia, which included patients with increased cIMT, and group Ib, which included patients with cIMT within normal ranges. Moreover, 20 age-matched and sex-matched apparently healthy volunteers were included as a control group (group II). Patients with BD were subjected to full history taking, thorough clinical examination, and assessment of disease activity according to Behçet’s Disease Current Activity Form score. The white blood cell count, neutrophil count, and lymphocytes count were recorded, and NLR was calculated. cIMT assessment was done for all participants.

Results

There were statistically significant differences (P< 0.05) regarding lymphocytes count and NLR and highly statistically significant difference (P< 0.001) regarding neutrophil count, being higher in patients with BD. There was a statistically highly significant difference (P< 0.001) regarding cIMT, being higher in group Ia patients (0.82±0.03) than group Ib patients (0.50±0.04) and healthy control group (0.47 ±0.04). There was a statistically significance positive correlation (R=639, P=0.005) between NLR and Behçet’s Disease Current Activity Form score. In conclusion, higher NLR values were recorded in patients with BD. Furthermore, patients with active BD had higher NLR values than inactive, and NLR is higher in patients with increased cIMT; thus, NLR may be an important bio-index for detecting BD activity and the presence of vascular affection.

References

  1. Nair JR, Moots RJ. Behcet’s disease. Clin Med (Lond) 2017; 17:71–77.

    Article  Google Scholar 

  2. Emmi G, Silvestri E, Squatrito D, Amedei A, Niccolai E, Milco D’Elios M, et al. Thrombosis in vasculitis: from pathogenesis to treatment. Thromb J 2015; 13:15.

    Article  Google Scholar 

  3. Mercan R, Bitik B, Tufan A, Bozbulut UB, Atas N, Ozturk MA, et al. The association between neutrophil/lymphocyte ratio and disease activity in rheumatoid arthritis and ankylosing spondylitis. J Clin Lab Anal 2015; 30:597–601.

    Article  Google Scholar 

  4. Yang Z, Liang Y, Xi W, Li C, Zhong R. Association of increased serum IL-33 levels with clinical and laboratory characteristics of systemic lupus erythematosus in Chinese population. Clin Exp Med 2011; 11:75–80.

    Article  CAS  Google Scholar 

  5. Yuksel M, Yildiz A, Oylumlu M, Mehmet B, Bilik M, Ekinci A, et al. Novel markers of endothelial dysfunction and inflammation in Behçet’s disease patients with ocular involvement: epicardial fat thickness, carotid intima media thickness, serum ADMA level, and neutrophil-to-lymphocyte ratio. Clin Rheumatol 2016; 35:701–708.

    Article  Google Scholar 

  6. Safak S, Uslu AU, Serdal K, et al. Association between mean platelet volume levels and inflammation in SLE patients presented with arthritis. Afr Health Sci 2014; 14:919–924.

    Article  Google Scholar 

  7. Rifaioglu EN, BulbulŞen B, Ekiz O, et al. Neutrophil to lymphocyte ratio in Behcet’s disease as a marker of disease activity. Acta Dermatovenerol Alp Pannonica Adriat 2014; 23:65–67.

    PubMed  Google Scholar 

  8. Qin B, Ma N, Tang Q, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol 2016; 26:372–376.

    Article  Google Scholar 

  9. Azab B, Torbey E, Singh J, et al. Mean platelet volume/platelet count ratio as a predictor of long-term mortality after non-ST-elevation myocardial infarction. Platelets 2011; 22:557–566.

    Article  CAS  Google Scholar 

  10. Yazici S, Yazici M, Erer B, et al. The platelet functions in patients with ankylosing spondylitis: anti-TNF-α therapy decreases the mean platelet volume and platelet mass. Platelets 2010; 21:126–131.

    Article  CAS  Google Scholar 

  11. Davatchi F, Assaad-Khalil S, Calamia KT, Crook J, Sadeghi-Abdollahi B, Schirmer M, et al. International study group for Behçet’s disease. Criteria for diagnosis of Behçet’s disease. Lancet 1990; 335:1078–1080.

    Google Scholar 

  12. Altac M, Tu Y, Yurdakul S, Binyildiz P, Yazici H. The validity of the pathergy test (non-specific skin hyperreactivity) in Behcet’s disease: a double-blind study by independent observers. Acta Derm Venereol 1982; 62:158–159.

    CAS  PubMed  Google Scholar 

  13. Suzuki N, Nara K, Suzuki T. Skewed Th1 responses caused by excessive expression of Txk, a member of the Tec family of tyrosine kinases, in patients with Behcet’s disease.. Clin Med Res 2006; 4:147–151.

    Article  CAS  Google Scholar 

  14. Ozturk C, Balta S, Balta I, Demirkol S, Celik T, Turker T, Iyisoy A. Neutrophil lymphocyte ratio and carotid-intima media thickness in patients with Behçet disease without cardiovascular involvement. Angiology 2015; 66:291–296.

    Article  Google Scholar 

  15. El-Gazzar I, El-Dakrony A, Sayed S, et al. Clinical significance of metabolic syndrome and carotid intima media thickness in Behcet’s disease patients: relation to disease activity. Egypt Rheumatol 2017; 3:171–174.

    Article  Google Scholar 

  16. Pancar GS, Kalkan G. Diagnostic value of Hb A1c level in Behcet’s disease and evaluation of neutrophil-lymphocyte ratio, mean platelet volume and body mass index. J Hematol 2015; 4:219–222.

    Article  CAS  Google Scholar 

  17. Yolpas S, Yildirim A, Gozel N, Koca S. Hematological indices may be useful in diagnosis of systemic lupus erythematosus and in determining disease activity in Behcet’s disease. Med Princ Pract 2016; 25:510–516.

    Article  Google Scholar 

  18. Macey M, Hagi-Pavli E, Stewart J, Wallace GR, Stanford M,Shirlaw P,et al. Age, gender and disease-related platelet and neutrophil activation ex vivo in whole blood samples from patients with Behcet’s disease. Rheumatology (Oxford) 2011; 50:1849–1859.

  19. Ricart JM, Espana F, Navarro S, Vayá A. Mean platelet volume does not seem to relate to thrombosis or posterior uveitis in Behçet’s disease. Clin Hemorheol Microcirc 2013; 54:51–57.

    Article  CAS  Google Scholar 

  20. Oylumlu M, Doğan A, Oylumlu M, et al. Relationship between platelet to lymphocyte ratio and coronary slow flow. Anatol J Cardiol 2015; 15:391–395.

    Article  CAS  Google Scholar 

  21. Ozturk C, Balta S, Balta I, et al. Neutrophillymphocyte ratio and carotid-intima media thickness in patients with Behçet disease without cardiovascular involvement. Angiology 2015; 66:291–296.

    Article  Google Scholar 

  22. Yüksel S, Kucukazman SO, Karataş GS, Ozturk M, Prombhul S, Hirankarn N. Methylation status of Alu and Line 1 interspersed repetitive sequences in Behcet’s disease patients. Bio Med Res 2016; 2016:1393089.

    Google Scholar 

  23. Onur E, Kabaroglu C, Inanir I, Var A, Guvenc Y, Gunay O, et al. Oxidative stress impairs endothelial nitric oxide levels in Behcets’ disease. Cutan Ocul Toxicol 2011; 30:217–220.

    Article  CAS  Google Scholar 

  24. Kiraz S, Ertenli I, Ozturk MA, Haznedaroglu IC, Celik I, Calguneri M. Pathological haemostasis and ‘prothrombotic state’ in Behcet’s disease. Thromb Res 2002; 105:125–133.

    Article  CAS  Google Scholar 

  25. Haznedaroglu S, Karaaslan Y, Buyukasik Y, Ozcebe A, Haznedaroglu A, Kirazli S, Dundar S. Selectin adhesion molecules in Behcet’s disease. Ann Rheum Dis 2000; 59:61–63.

    Article  CAS  Google Scholar 

  26. Kosar A, Haznedaroglu S, Karaaslan Y, et al. Effects of interferon-alpha2a treatment on serum levels of tumor necrosis factor-alpha, tumor necrosis factor-alpha2 receptor, interleukin-2, interleukin-2 receptor, and E-selectin in Behcet’s disease. Rheumatol Int 1999; 19:11–14.

    Article  CAS  Google Scholar 

  27. Balta I, Balta S, Koryurek OM, et al. Mean platelet volume is associated with aortic arterial stiffness in patients with Behcet’s disease without significant cardiovascular involvement. J Eur Acad Dermatol Venereol 2014; 28:1388–1393.

    Article  CAS  Google Scholar 

  28. Ozturk C, Sevket B, Ilknur B, Sait D, Turgay C, Turker T, et al. Carotid–intima media thickness in patients with Behçet disease without cardiovascular involvement. Angiology 2015; 66:291–296.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Rheumatology and Rehabilitation, Benha Faculty of Medicine, Benha University, Egypt

    Mounir Serag Elden, Gamal Hmmad &  Rasha M. Fawzy (Assistant Professor)

  2. Diagnostic Radiology, Benha Faculty of Medicine, Benha University, Egypt

    Hesham Farouk

  3. MSc of Rheumatology and Rehabilitation, Benha Teaching Hospital, Egypt

    Basma Abdelwhaba

Authors
  1. Mounir Serag Elden
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gamal Hmmad
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hesham Farouk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rasha M. Fawzy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Basma Abdelwhaba
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rasha M. Fawzy.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elden, M.S., Hmmad, G., Farouk, H. et al. Neutrophil-to-lymphocyte ratio: relation to disease activity and carotid intima-media thickness in Behçet’s disease. Egypt Rheumatol Rehabil 45, 133–139 (2018). https://doi.org/10.4103/err.err_26_18

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/err.err_26_18

Keywords