The following is a summary of the “Red Cell Distribution Width and Absolute Lymphocyte Count Associate With Biomarkers of Inflammation and Subsequent Mortality in Rheumatoid Arthritis,” published in the February 2023 issue of Rheumatology by Lange, et al.
Upholding immune and hematologic homeostasis can lessen RA-related morbidity and mortality. However, it is difficult to determine who is at risk. Absolute lymphocyte count (ALC) and red cell distribution width (RDW) are linked to CVD and mortality in the general population and disease activity in RA, respectively. Therefore, researchers looked into the connections between inflammation and mortality in RA and the factors mentioned above. Before and during treatment for RA with methotrexate (MTX)+/- a tumor necrosis factor (TNF) inhibitor (TNFi), we analyzed RDW and ALC about mortality in a single retrospective cohort of 327 patients at the Veterans Affairs (VA) Rheumatology Clinic. Results were backed up by a large (n = 13,914) VA cohort nationwide.
They measured inflammatory markers in a sample of patients and healthy people. Both high RDW and low ALC before MTX treatment were associated with increased mortality over a 10-year follow-up in the local cohort (P<0.001). Those with a high RDW and a low ALC had the highest mortality rates. This was confirmed in the national RA cohort and held even after controlling for age and co-morbidities. Patients with RA had higher levels of soluble and cellular inflammatory markers than controls in the immunology cohort.
Age, plasma TNF receptor II, the mean fluorescence intensity of natural killer HLA-DR, and CD4+/CD8+ T cell ratio correlated with ALC. In contrast, RDW was correlated with both ALC and age. When MTX treatment began, it caused a rise in RDW and a fall in ALC. A higher amount of ALC was achieved by adding TNFi therapy to MTX. Biomarkers of monocyte/macrophage inflammation and mortality are linked to RDW and ALC before disease-modifying antirheumatic drug therapy. More research is needed to fully understand the significance of the mechanistic link between TNF signaling and lymphopenia found here.
Source: jrheum.org/content/50/2/166
