Correlation of Haematological Parameters and DAS-28 Score among Rheumatoid Arthritis Patients

Main Article Content

Muhammad Shiraz Niaz
Aflak Rasheed
Shujaat Hassan
Hussain Shakeel
Qaisar Farooq
Safia Niaz


Background: Rheumatoid arthritis (RA) is a complex inflammatory disorder with diverse clinical manifestations. While haematological parameters have long been suggested as potential surrogates for RA disease activity, their direct relationship with the DAS-28 score remains to be thoroughly charted.

Objective: To elucidate the correlation between specific haematological markers and RA disease activity, benchmarked against the DAS-28 score, and to determine the potential diagnostic value of these indices in RA monitoring and management.

Methods: In a cross-sectional survey spanning six months at Sheikh Zaid Hospital, Lahore, 104 RA patients were enrolled. Based on disease activity, participants were segmented into four groups. Comprehensive data capture encompassed demographics, clinical specifics, and haematological indicators. Advanced statistical processing, using SPSS, incorporated correlation computations, ANOVA, and ROC curve methodologies.

Results: DAS-28 scores aligned with disease severity, with averages of 2.13, 2.88, 3.98, and 5.61 for remission, low, moderate, and high activity levels respectively. Haemoglobin demonstrated a significant negative correlation with the DAS-28 score (Pearson's R = -0.485, p < 0.001). Conversely, RDW (%) (Pearson's R = 0.749, p < 0.001), Neutrophils (%) (Pearson's R = 0.691, p < 0.001), and NLR (Pearson’s R = 0.617, p < 0.001) all reflected robust positive correlations. Lymphocytes (%) showed a negative trend (Pearson's R = -0.475, p < 0.001). MPV (fl) and platelet count, however, did not indicate significant correlations.

Conclusion: Key haematological parameters, especially RDW, neutrophils, NLR, and inversely, haemoglobin and lymphocytes, manifest marked correlations with the DAS-28 score in RA patients. These indices could serve as valuable ancillary tools in assessing RA disease activity, particularly in settings with limited access to advanced diagnostic modalities.

Article Details

How to Cite
Niaz, M. S., Rasheed, A., Hassan , S., Shakeel, H., Farooq, Q., & Niaz , S. (2023). Correlation of Haematological Parameters and DAS-28 Score among Rheumatoid Arthritis Patients. Journal of Health and Rehabilitation Research, 3(2), 74–80. Retrieved from
Author Biographies

Muhammad Shiraz Niaz, Department of Rheumatology and Immunology-Shaikh Zayed Federal Postgraduate Medical Institute Lahore

MBBS, TR Rheumatology

Aflak Rasheed, Department of Rheumatology and Immunology-Shaikh Zayed Federal Postgraduate Medical Institute Lahore

MBBS, FCPS, Associate Professor of Rheumatology

Shujaat Hassan , Department of Rheumatology and Immunology-Shaikh Zayed Federal Postgraduate Medical Institute Lahore

MBBS, TR Rheumatology

Hussain Shakeel, Department of Rheumatology and Immunology-Shaikh Zayed Federal Postgraduate Medical Institute Lahore

MBBS, TR Rheumatology

Qaisar Farooq, Department of Rheumatology and Immunology-Shaikh Zayed Federal Postgraduate Medical Institute Lahore

MBBS, TR Rheumatology

Safia Niaz , National University of Sciences and Technology Islamabad

PhD Scholar


Ahmed MH, Ghatge MS, Safo MK. Hemoglobin: Structure, Function and Allostery. In: Hoeger U, Harris JR, editors. Vertebrate and Invertebrate Respiratory Proteins, Lipoproteins and other Body Fluid Proteins. Cham: Springer International Publishing; 2020. p. 345-82.

Kim H, Sung Y-K. Epidemiology of Rheumatoid Arthritis in Korea. jrd. 2021;28(2):60-7.

Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, et al. Rheumatoid arthritis. Nature Reviews Disease Primers. 2018;4(1):18001.

Zhu Y, Zhao T, Liu M, Wang S, Liu S, Yang Y, et al. Rheumatoid arthritis microenvironment insights into treatment effect of nanomaterials. Nano Today. 2022;42:101358.

Bobircă A, Bobircă F, Ancuța I, Florescu A, Bojincă M, Muscă A, et al. COVID-19—a trigger factor for severe immune-mediated thrombocytopenia in active rheumatoid arthritis. Life. 2022;12(1):77.

Guo Q, Wang Y, Xu D, Nossent J, Pavlos NJ, Xu J. Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies. Bone research. 2018;6:15.

Song J-W, Zhang C, Fan X, Meng F-P, Xu Z, Xia P, et al. Immunological and inflammatory profiles in mild and severe cases of COVID-19. Nature communications. 2020;11(1):3410.

Atwa ET, Omar HM, Amin A, Hammad M. Red cell distribution width and mean platelet volume in rheumatoid arthritis patients: Its association with disease activity. Reumatología Clínica. 2022;18(7):399-405.

El-Jawhari JJ, El-Sherbiny Y, McGonagle D, Jones E. Multipotent mesenchymal stromal cells in rheumatoid arthritis and systemic lupus erythematosus; from a leading role in pathogenesis to potential therapeutic saviors? Frontiers in Immunology. 2021;12:643170.

Scherer HU, Häupl T, Burmester GR. The etiology of rheumatoid arthritis. Journal of autoimmunity. 2020;110:102400.

Farooqi A, Gibson T. Prevalence of the major rheumatic disorders in the adult population of north Pakistan. British journal of rheumatology. 1998;37(5):491-5.

Mohsin Z, Asghar AA, Faiq A, Khalid I, Ul-Haque I, Rehman S, et al. Prevalence of Rheumatic Diseases in a Tertiary Care Hospital of Karachi. Cureus. 2018;10(6):e2858.

Tekeoğlu İ, Gürol G, Harman H, Karakeçe E, Çiftçi İH. Overlooked hematological markers of disease activity in rheumatoid arthritis. International Journal of Rheumatic Diseases. 2016;19(11):1078-82.

Quaiser S, Khan R. Correlation of neutrophil-lymphocyte ratio with disease activity in rheumatoid arthritis. Journal of Clinical Sciences. 2020;17:46.

Abd-Elazeem MI, Mohamed RA. Neutrophil-lymphocyte and platelet-lymphocyte ratios in rheumatoid arthritis patients: Relation to disease activity. The Egyptian Rheumatologist. 2018;40(4):227-31.

Talukdar M, Barui G, Adhikari A, Karmakar R, Ghosh UC, Das TK. A Study on Association between Common Haematological Parameters and Disease Activity in Rheumatoid Arthritis. Journal of clinical and diagnostic research : JCDR. 2017;11(1):Ec01-ec4.

Yang W-m, Zhang W-h, Ying H-q, Xu Y-m, Zhang J, Min Q-h, et al. Two new inflammatory markers associated with disease activity score-28 in patients with rheumatoid arthritis: Albumin to fibrinogen ratio and C-reactive protein to albumin ratio. International Immunopharmacology. 2018;62:293-8.

Ball S, Dennis JA, Bedanie G, Nugent K. Relation between mean platelet volume and C-reactive protein. Baylor University Medical Center Proceedings. 2020;33(2):163-8.

Pope JE, Choy EH. C-reactive protein and implications in rheumatoid arthritis and associated comorbidities. Seminars in Arthritis and Rheumatism. 2021;51(1):219-29.

Riedl JM, Barth DA, Brueckl WM, Zeitler G, Foris V, Mollnar S, et al. C-Reactive Protein (CRP) Levels in Immune Checkpoint Inhibitor Response and Progression in Advanced Non-Small Cell Lung Cancer: A Bi-Center Study. Cancers. 2020;12(8):2319.

Sadeghi-Haddad-Zavareh M, Bayani M, Shokri M, Ebrahimpour S, Babazadeh A, Mehraeen R, et al. C-Reactive Protein as a Prognostic Indicator in COVID-19 Patients. Interdisciplinary Perspectives on Infectious Diseases. 2021;2021:5557582.


Liu Y, Zhu Y, Jia W, Sun D, Zhao L, Zhang C, et al. Association of the total white blood cell, neutrophils, and monocytes count with the presence, severity, and types of carotid atherosclerotic plaque. Frontiers in Medicine. 2020;7:313.

Seyit M, Avci E, Nar R, Senol H, Yilmaz A, Ozen M, et al. Neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio and platelet to lymphocyte ratio to predict the severity of COVID-19. The American journal of emergency medicine. 2021;40:110-4.

Agarwal N, Kapoor S, Garg SR, Dubey S, AN M, Nagpal PS. Association of disease activity score (DAS) 28 with subsets of rheumatoid factor and anti-cyclic citrullinated peptides (anti-CCP) among rheumatoid arthritis patients in North India. 2023.

Dakhil AS. Association of serum concentrations of proinflammatory cytokines and hematological parameters in rheumatoid arthritis patients. Journal of Pharmaceutical Sciences and Research. 2017;9(10):1966-74.

Dechanuwong P, Phuan-Udom R. Hematological parameters as a predictor of disease remission in patients with rheumatoid arthritis. Annals of medicine and surgery (2012). 2021;72:103085.

Tekeoğlu İ, Gürol G, Harman H, Karakeçe E, Çiftçi İHJIjord. Overlooked hematological markers of disease activity in rheumatoid arthritis. 2016;19(11):1078-82.

Remalante PPM, Salido EO, Penserga EG, Gauiran DTV. Red cell distribution width and neutrophil–lymphocyte ratio in rheumatoid arthritis. Rheumatology International. 2020;40(10):1631-7.

Pereckova J, Martiniakova S, Payer J, Falk M, Killinger Z, Perecko T. Analysis of hematological parameters in rheumatoid arthritis patients receiving biological therapy: contribution to prevention of avoidable hematological complications. EXCLI journal. 2022;21:580-94.

Korniluk A, Koper-Lenkiewicz OM, Kamińska J, Kemona H, Dymicka-Piekarska V. Mean Platelet Volume (MPV): New Perspectives for an Old Marker in the Course and Prognosis of Inflammatory Conditions. Mediators of Inflammation. 2019;2019:9213074.

Greenmyer JR, Stacy JM, Sahmoun AE, Beal JR, Diri E. DAS28-CRP Cutoffs for High Disease Activity and Remission Are Lower Than DAS28-ESR in Rheumatoid Arthritis. ACR open rheumatology. 2020;2(9):507-11.

Choe J-Y, Lee CU, Kim S-K. Association between Novel Hematological Indices and Measures of Disease Activity in Patients with Rheumatoid Arthritis. Medicina. 2023;59(1):117