Elevated neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios are associated with increased flares and elevated cardiovascular disease risk in gout.

Abstract

Objective: Although gout is the most common inflammatory arthritis, there are few tools to monitor disease activity and predict complications in gout patients. The neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are associated with disease activity in various diseases and the NLR has been shown to predict coronary artery disease severity, a common comorbid condition with gout. Thus, we evaluated the use of NLR and MLR as novel biomarkers to measure disease activity and predict cardiovascular disease (CVD) risk in gout patients.

Method: Data were collected from 38 gout patients. Disease activity, including total number of acute gout attacks, and 10 year risk of cardiovascular morbidity, were assessed at the patient's visit. Calprotectin, cell counts, and uric acid levels were measured from patients' blood.

Results: Levels of the neutrophil activation marker calprotectin correlated with NLR (r = 0.56, p = 0.0004). MLR correlated with total number of gout attacks as well (r = 0.39, p = 0.02). NLR and MLR, but not absolute monocyte or neutrophil counts, were significantly correlated with body mass index and significantly increased in gout patients with high CVD risk (p < 0.05). Using logistic regression analysis, patients with high NLR or MLR (defined as the upper quartile of patients) had increased odds of developing high CVD risk (odds ratio 7.5, 95% confidence interval 1.7-33.0).

Conclusion: NLR and MLR are potential biomarkers to predict gout flare risk. An increase in either may indicate an increased risk of CVD morbidity.