Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of the prognostic nutritional index (PNI) as a tool for assessing disease activity in rheumatoid arthritis patients

  • ORIGINAL ARTICLE
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Objectives

Rheumatoid arthritis (RA) is an autoimmune disease of unknown exact cause, characterized by chronic inflammation. The prognostic nutritional index (PNI), reflecting albumin concentration and lymphocyte count, is a newly established inflammation-based nutritional score. This study aimed to determine the relationship between PNI and disease activity in RA patients.

Patients and methods

This cross-sectional study included 138 RA patients who met the 2010 revised criteria of the American College of Rheumatology (ACR) for RA. PNI was calculated using the following formula: 10 × serum albumin value (g/dL) + 0.005 × total lymphocyte count in the peripheral blood (per mm3). The study population was divided into two groups: DAS28-ESR ≤ 3.2 (group 1 with remission and low disease activity) and DAS28-ESR > 3.2 (group 2 with moderate and high disease activity).

Results

A total of 138 patients with a mean age of 52.1 years were recruited. While the female gender was more prevalent in both groups, it was significantly higher in group 2 (p < 0.05). Group 2 exhibited a lower PNI compared to those in group 1 (42.17 ± 3.46 vs. 44.02 ± 2.92; p = 0.001). Multivariate logistic regression analyses revealed that PNI was an independent predictor of disease activity (OR, 0.850; 95% CI, 0.735–0.983; p = 0.029). ROC curve analysis determined that the optimal cutoff value of PNI for disease activity was 43.01, with a sensitivity of 69.1% and specificity of 57.7% (AUC, 0.66; 95% CI, 0.57–0.75, p = 0.001).

Conclusion

This study demonstrates that the simple and readily available PNI could serve as an independent predictor of disease activity in rheumatoid arthritis patients.

Key Points

•The relationship between disease activity and the prognostic nutritional index, which is a nutritional indicator, in rheumatoid arthritis patients was investigated.

•It has been shown that there is a connection between low PNI and high disease activity.

•It has been shown that PNI can be used to evaluate disease severity with a simple calculation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. McInnes IB, Schett G (2011) The pathogenesis of rheumatoid arthritis. N Engl J Med 365(23):2205–2219

    Article  CAS  PubMed  Google Scholar 

  2. Scott DL, Wolfe F, Huizinga TW (2010) Rheumatoid arthritis. Lancet 376(9746):1094–1108

    Article  PubMed  Google Scholar 

  3. Venetsanopoulou AI, Alamanos Y, Skalkou A et al (2023) The changing incidence of rheumatoid arthritis over time in north-west Greece: data from a referral centre. Scand J Rheumatol 52(4):327–334

    Article  CAS  PubMed  Google Scholar 

  4. Hasegawa H (2018) Assessment of disease activity, structural damage, and function in rheumatoid arthritis. Methods Mol Biol 1868:243–250

    Article  CAS  PubMed  Google Scholar 

  5. Kay J, Morgacheva O, Messing SP et al (2014) Clinical disease activity and acute phase reactant levels are discordant among patients with active rheumatoid arthritis: acute phase reactant levels contribute separately to predicting outcome at one year. Arthritis Res Ther 16(1):R40

    Article  PubMed  PubMed Central  Google Scholar 

  6. van Riel PL, Renskers L (2016) The Disease Activity Score (DAS) and the Disease Activity Score using 28 joint counts (DAS28) in the management of rheumatoid arthritis. Clin Exp Rheumatol 34(5 Suppl 101):S40–S44

    PubMed  Google Scholar 

  7. Inciarte-Mundo J, Frade-Sosa B, Sanmartí R (2022) From bench to bedside: calprotectin (S100A8/S100A9) as a biomarker in rheumatoid arthritis. Front Immunol 13:1001025

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Onodera T, Goseki N, Kosaki G (1984) Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi 85(9):1001–1005

    CAS  PubMed  Google Scholar 

  9. Seo M, Yamada T, Morita T et al (2018) Prognostic value of systemic immune-inflammation index in patients with chronic heart failure. Eur Heart J 39:70–71

    Article  Google Scholar 

  10. Jeong Y, Jeon SR, Kim HG et al (2021) The role of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in ulcerative colitis. Intest Res 19(1):62–70

    Article  PubMed  Google Scholar 

  11. Aletaha D, Neogi T, Silman AJ et al (2010) 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 62(9):2569–2581

    Article  PubMed  Google Scholar 

  12. Bitik B, Mercan R, Tufan A et al (2015) Differential diagnosis of elevated erythrocyte sedimentation rate and C-reactive protein levels: a rheumatology perspective. Eur J Rheumatol 2(4):131–134

    Article  PubMed  PubMed Central  Google Scholar 

  13. Šućur A, Jajić Z, IkićMatijašević M et al (2020) Combined manual and automated immunophenotypisation identified disease-specific peripheral blood immune subpopulations in rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Clin Exp Rheumatol 38(5):903–916

    PubMed  Google Scholar 

  14. Ahn SS, Jung SM, Song JJ et al (2019) Prognostic nutritional index is associated with disease severity and relapse in ANCA-associated vasculitis. Int J Rheum Dis 22(5):797–804

    Article  CAS  PubMed  Google Scholar 

  15. Ataş N, Babaoğlu H, Demirel E et al (2020) Use of prognostic nutritional index in the evaluation of disease activity in patients with Behçet’s disease. Eur J Rheumatol 7(3):99–104

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wunder A, Müller-Ladner U, Stelzer EH et al (2003) Albumin-based drug delivery as novel therapeutic approach for rheumatoid arthritis. J Immunol 170(9):4793–4801

    Article  CAS  PubMed  Google Scholar 

  17. Levick JR (1981) Permeability of rheumatoid and normal human synovium to specific plasma proteins. Arthritis Rheum 24(12):1550e60

    Article  Google Scholar 

  18. Wilkinson P, Jeremy R, Brooks FP, Hollander JL (1965) The mechanism of hypo-albuminemia in rheumatoid arthritis. Ann Intern Med 63:109e14

    Article  Google Scholar 

  19. Moshage HJ, Janssen JA, Franssen JH, Hafkenscheid JC, Yap SH (1987) Study of the molecular mechanism of decreased liver synthesis of albumin in inflamma- tion. J Clin Invest 79(6):1635e41

    Article  Google Scholar 

  20. Kaplan H, Cengiz G, Şaş S et al (2023) Is the C-reactive protein-to-albumin ratio the most remarkable simple inflammatory marker showing active disease in patients with axial spondyloarthritis, psoriatic arthritis, and rheumatoid arthritis? Clin Rheumatol 42(11):2959–2969

    Article  PubMed  Google Scholar 

  21. Zhang H, Yang G, Jiang R et al (2023) Correlation between total bilirubin, total bilirubin/albumin ratio with disease activity in patients with rheumatoid arthritis. Int J Gen Med 16:273–280

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Chandrashekara S, Mukhtar Ahmad M, Renuka P et al (2017) Characterization of neutrophil-to-lymphocyte ratio as a measure of inflammation in rheumatoid arthritis. Int J Rheum Dis 20(10):1457–1467

    Article  CAS  PubMed  Google Scholar 

  23. Fu X, Liu H, Huang G et al (2021) The emerging role of neutrophils in autoimmune-associated disorders: effector, predictor, and therapeutic targets. MedComm 2(3):402–413

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Targońska-Stępniak B, Zwolak R, Piotrowski M et al (2020) The relationship between hematological markers of systemic inflammation (neutrophil-to-lymphocyte, platelet-to-lymphocyte, lymphocyte-to-monocyte ratios) and ultrasound disease activity parameters in patients with rheumatoid arthritis. J Clin Med 9(9):2760

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ahn SS, Jung SM, Song JJ et al (2018) Prognostic nutritional index is correlated with disease activity in patients with systemic lupus erythematosus. Lupus 27(10):1697–1705

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Rheumatology Division, Physical Medicine and Rehabilitation Department, Marmara University School of Medicine, Muhsin Yazıcıoğlu Street, No 10, 34899, Istanbul, Türkiye

    Nuran Öz, Halise Hande Gezer & Mehmet Tuncay Duruöz

  2. Rheumatology Division, Istanbul Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye

    Selin Cilli Hayıroğlu

Authors
  1. Nuran Öz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Halise Hande Gezer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Selin Cilli Hayıroğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mehmet Tuncay Duruöz
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Nuran Öz: conceptualization, methodology, investigation, data curation, writing—original draft preparation, and visualization.  Halise Hande Gezer: conceptualization, methodology, investigation, data curation, and writing—original draft preparation.  Selin Cilli Hayıroğlu: conceptualization, methodology, investigation, data curation, and writing—review and editing.  Mehmet Tuncay Duruöz: conceptualization, methodology, supervision, writing—review and editing, and project administration.

Corresponding author

Correspondence to Nuran Öz.

Ethics declarations

Disclosures

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Öz, N., Gezer, H.H., Cilli Hayıroğlu, S. et al. Evaluation of the prognostic nutritional index (PNI) as a tool for assessing disease activity in rheumatoid arthritis patients. Clin Rheumatol 43, 1461–1467 (2024). https://doi.org/10.1007/s10067-024-06927-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-024-06927-2

Keywords

Search

Navigation