Platelet Indices Are Associated with Disease Activity Scores and the Severity of Sacroiliitis on Magnetic Resonance Imaging in Axial Spondyloarthritis Patients

Kwi Young Kang; Joon-Yong Jung; Ji Hyeon Ju; Sung-Hwan Park; Yeon-Sik Hong

doi:10.4078/jrd.2016.23.5.288

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Kang, Jung, Ju, Park, and Hong: Platelet Indices Are Associated with Disease Activity Scores and the Severity of Sacroiliitis on Magnetic Resonance Imaging in Axial Spondyloarthritis Patients

Original Article

J Rheum Dis 2016;23(5):288-296.

Published online: 31 October 2016

DOI: https://doi.org/10.4078/jrd.2016.23.5.288

Platelet Indices Are Associated with Disease Activity Scores and the Severity of Sacroiliitis on Magnetic Resonance Imaging in Axial Spondyloarthritis Patients

Kwi Young Kang^1,², Joon-Yong Jung³, Ji Hyeon Ju¹, Sung-Hwan Park¹, Yeon-Sik Hong^1,²

¹Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

²Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Korea

³Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea

Corresponding to: Kwi Young Kang, Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, 56 Dongsu-ro, Bupyeong-gu, Incheon 21431, Korea. E-mail: kykang@catholic.ac.kr

Received 6 July 201627 September 2016 Accepted 12 October 2016

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To investigate the associations among platelet indices, disease activity scores, and inflammatory markers in axial spondyloarthritis, and to determine the relation between platelet indices and inflammation measured on magnetic resonance imaging (MRI).

Methods

The study included 161 patients who fulfilled Assessment of Spondyloarthritis International Society criteria. Platelet indices such as mean platelet volume (MPV), plateletcrit (PCT), platelet large cell ratio (PLCR), and platelet distribution width (PDW) were measured. Ninety patients underwent sacroiliac (SI) MRI at baseline. Bone marrow edema (BME) and erosion on MRI were scored using the SPondyloArthritis Research Consortium of Canada (SPARCC) method. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Disease Activity Score (ASDAS) and spinal radiologic progression were also assessed. The associations among platelet indices and disease activity scores and inflammatory markers were evaluated.

Results

Of the 161 patients, 130 (81%) were male. MPV, PLCR, and PDW were negatively associated with ASDAS and inflammatory marker expression, whereas PCT was positively associated with these parameters. MPV, PLCR, and PDW were negatively associated with BME and erosion scores on SI MRI. However, platelet indices were not associated with the BASDAI and BASFI. The mean erythrocyte sedimentation rate, C-reactive protein, and BME and erosion scores were significantly higher in patients with low MPV. Changes in MPV, PCT, and PDW at baseline and after one year were associated with changes in ASDAS and inflammatory marker expression.

Conclusion

Platelet indices are associated with ASDAS, inflammatory marker levels, and severity of BME and erosion measured on MRI.

Keywords: Platelet index, Bone marrow edema, Erosion, Axial spondyloarthritis, Magnetic resonance imaging

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Table 1.

Baseline characteristics of patients with axial spondy loarthritis

Characteristic (n=161)
Male	130 (80.7)
Age (yr)	35.9±12.5
Time from symptoms onset (yr)	7.6±9.2
Time from diagnosis (yr)	3.3±6.0
Smoking, current	56 (34.8)
Family history	23 (14.3)
HLA B27-positive	135 (83.9)
Patient global assessment	5.1±2.3
BASDAI, score (range, 0∼10)	4.4±2.2
BASFI, score	2.0±2.3
ASDAS-ESR	2.8±1.1
ASDAS-CRP	2.5±1.2
ESR, mm/hr	23.4±22.3
CRP, mg/L	10.2±17.8
Grade of sacroiliitis on X-ray	2.3±1.2
mSASSS	8.9±16.6
Number of syndesmophytes	3.0±6.2
Patients taking NSAIDs	150 (93.2)
Patients taking sulfasalazine	47 (29.2)
Patients taking MTX	5 (3.1)
Patients taking TNF inhibitors	14 (8.7)
Hemoglobin (g/dL)	14.4±1.7
Platelet (10³/mm³)	276.5±57.6
Platelet count (×10³/μ L)	271.8±59.2
MPV (fL)	9.7±0.8
PCT (%)	0.26±0.05
PLCR (%)	21.7±6.3
PDW (fL)	10.5±1.7

Values are presented as mean±standard deviation an number (%). HLA: human leukocyte antigen, BASDAI: Bat Ankylosing Spondylitis Disease Activity Index, BASFI: Bat Ankylosing Spondylitis Functional Index, ASDAS: Ankylosin Spondylitis Disease Activity Score, ESR: erythrocyte sed mentation rate, CRP: C-reactive protein, mSASSS: modifie Stoke Ankylosing Spondylitis Spinal Score, NSAIDs: non steroidal anti-inflammatory drugs, MTX: methotrexate, TNF tumor necrosis factor, MPV: mean platelet volume, PCT plateletcrit, PLCR: platelet large cell ratio, PDW: platele distribution width.

Table 2.

Correlation between platelet indices and disease activity variables in patients with axial spondylarthritis

Variable	MPV (fL)	PCT (%)	PLCR (%)	PDW (fL)	Platelet (10³/mm³)	Hb (g/dL)
Disease activity variables
BASDAI	−0.106 (0.183)	0.138 (0.081)	−0.110 (0.164)	−0.121 (0.126)	0.089 (0.408)	−0.109 (0.312)
BASFI	−0.083 (0.299)	0.127 (0.111)	−0.086 (0.282)	−0.105 (0.186)	0.187 (0.082)	−0.206 (0.054)
PGA score	−0.059 (0.462)	0.082 (0.302)	−0.063 (0.429)	−0.063 (0.430)	0.090 (0.407)	−0.089 (0.407)
ASDAS-ESR	−0.200 (0.011)^*	0.216 (0.006)^**	−0.204 (0.010)^*	−0.200 (0.011)^*	0.257 (0.014)^*	−0.259 (0.013)^*
ASDAS-CRP	−0.166 (0.036)^*	0.229 (0.004)^**	−0.164 (0.038)^*	−0.168 (0.034)^*	0.171 (0.033)^*	−0.225 (0.035)^*
ESR	−0.253 (0.001)^**	0.391 (<0.001)^**	−0.256 (0.001)^**	−0.269 (0.001)^**	0.548 (C0.001)^**	−0.586 (C0.001)^**
CRP	−0.228 (0.004)^**	0.163 (0.039)^*	−0.224 (0.004)^*	−0.219 (0.005)^**	0.216 (0.006)^**	−0.204 (0.010)^*
Sacroiliac MRI findings
Erosion	−0.319 (0.002)^**	0.060 (0.577)	−0.309 (0.003)^*	−0.262 (0.013)^*	0.218 (0.053)	−0.176 (0.099)
Bone marrow edema	−0.257 (0.014)^*	0.209 (0.048)^*	−0.263 (0.012)^*	−0.251 (0.017)^*	0.272 (0.013)^*	−0.120 (0.264)

Data are expressed as r coefficients (p-value). MPV: mean platelet volume, PCT: plateletcrit, PLCR: platelet large cell ratio, PDW: platelet distribution width, Hb: hemoglobin, BASDAI: Bath Ankylosing Spondylitis Disease Activity Index, BASFI: Bath Ankylosing Spondylitis Functional Index, PGA: patient global assessment, ASDAS: Ankylosing Spondylitis Disease Activity Score, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein, MRI: magnetic resonance imaging.

^* p<0.05

^** p<0.01.

Table 3.

Disease activity scores and MRI findings at the sacroiliac joints according to MPV and PDW values

Variable	MPV (fL)			PDW (fL)
Variable	<9.1 (n=30)	≥9.1 (n=131)	p-value	<9.3 (n=32)	≥9.3 (n=129)	p-value
Disease activity variables
BASDAI	4.5±2.2	4.4±2.2	0.843	4.4±2.4	4.4±2.1	0.962
ASDAS-ESR	3.0±1.3	2.8±1.1	0.226	3.0±1.3	2.8±1.1	0.278
ASDAS-CRP ESR, mm/h	2.7±1.4 32.0±26.3	2.5±1.2 21.3±21.0	0.472 0.018^*	2.6±1.4 31.4±25.8	2.5±1.2 21.4±21.1	0.518 0.047^*
CRP, mg/l	17.9±25.7	8.5±15.0	0.008^**	17.5±25.1	8.4±15.1	0.010^*
Sacroiliac MRI findings
Erosion	6.6±3.1	4.4±4.4	0.032^*	5.4±3.6	4.5±4.5	0.219
Bone marrow edema	14.0±12.9	6.3±3.4	0.017^*	11.9±11.8	6.3±6.5	0.033^*

Values are presented as mean±standard deviation. MRI: magnetic resonance imaging, MPV: mean platelet volume, PDW: platelet distribution width, BASDAI: Bath Ankylosing Spondylitis Disease Activity Index, ASDAS: Ankylosing Spondylitis Disease Activity Score, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein.

^* p<0.05

^** p<0.01.

Table 4.

Correlation between platelet indices, disease activity scores, inflammatory marker levels, and the severity of sacroiliitis on MRI (stratified according to symptom duration)

Variable (r coefficient)	ASDAS-ESR	ASDAS-CRP	ESR	CRP	Erosion	Bone marrow edema
Symptom duration ≤3 years (n=67)
MPV	−0.338^**	−0.301^*	−0.417^**	−0.339^**	−0.303^*	−0.375^**
PCT	0.164	0.233	0.378^**	0.251^*	0.185	0.194
PLCR	−0.323^**	−0.273^*	−0.400^**	−0.318^**	−0.293^*	−0.370^**
PDW	−0.332^**	−0.261^*	−0.402^**	−0.311^*	−0.279	−0.370^**
Symptom duration >3 years (n=94)
MPV	−0.108	−0.073	−0.147	−0.136	−0.329^*	0.097
PCT	0.261^*	0.236^*	0.406^**	0.104	−0.031	0.163
PLCR	−0.123	−0.087	−0.164	−0.142	−0.334^*	0.062
PDW	−0.121	−0.109	−0.194	−0.151	−0.267	0.093

Ninety patients underwent sacroiliac MRI to assess erosion and bone marrow edema. MRI: magnetic resonance imaging, MPV: mean platelet volume, PCT: plateletcrit, PLCR: platelet large cell ratio, PDW: platelet distribution width, ASDAS: Ankylosing Spondylitis Disease Activity Score, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein.

^* p<0.05

^** p<0.01.

Table 5.

Correlation between differences in platelet indices, disease activity scores, and inflammatory markers at baseline and at 1 year in patients with axial spondyloarthritis

Difference (Baseline value–FU value)	ASDAS-ESR	ASDAS-CRP	ESR	CRP
MPV	−0.474 (0.026)^*	−0.452 (0.035)^*	−0.297 (−0.180)	−0.459 (0.031)^*
PCT	0.521 (0.013)^*	0.461 (0.031)^*	0.648 (0.001)^**	0.398 (0.066)
PLCR	−0.327 (0.138)	−0.333 (0.130)	−0.249 (0.264)	−0.349 (0.112)
PDW	−0.571 (0.005)^**	−0.493 (0.020)^*	−0.552 (0.008)^**	−0.409 (0.059)

Data are expressed as r coefficients (p-value). ASDAS: Ankylosing Spondylitis Disease Activity Score, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein, MPV: mean platelet volume, PCT: plateletcrit, PLCR: platelet large cell ratio, PDW: platelet distribution width.

^* p<0.05

^** p<0.01.

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