Value of Albumin-Fibrinogen Ratio and CRP-Albumin Ratio as Predictor Marker of Disease Activity in Egyptian RA Patients, Correlated with Musculoskeletal Sonography

Naglaa Afifi; Basma M Medhat; Amani Mohamed Abdel Ghani; Hend Galal Eldeen Mohamed Ali Hassan; Mervat E Behiry

doi:10.2147/OARRR.S268668

Value of Albumin-Fibrinogen Ratio and CRP-Albumin Ratio as Predictor Marker of Disease Activity in Egyptian RA Patients, Correlated with Musculoskeletal Sonography

Open Access Rheumatol. 2020 Nov 2:12:241-248. doi: 10.2147/OARRR.S268668. eCollection 2020.

Authors

Naglaa Afifi^{1

2}, Basma M Medhat³, Amani Mohamed Abdel Ghani⁴, Hend Galal Eldeen Mohamed Ali Hassan⁵, Mervat E Behiry^{2

6}

Affiliations

¹ Internal Medicine and Rheumatology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
² Internal Medicine, Armed Forces College of Medicine (AFCM), Cairo, Egypt.
³ Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁴ Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
⁵ Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
⁶ Internal Medicine, and Rheumatology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Abstract

Purpose: To evaluate the albumin-fibrinogen ratio (AFR) and C-reactive protein-albumin ratio (CAR) as inflammatory markers in rheumatoid arthritis (RA) and to investigate their association with disease activity correlating with musculoskeletal ultrasonographic findings.

Patients and methods: A total of 125 cases of RA patients were consecutively enrolled in a multicenter cross-sectional study compared to 100 healthy controls, all subjects were investigated for fibrinogen, albumin, CRP, erythrocyte sedimentation rate, AFR, and CAR measurements. Patients' disease activity was assessed by disease activity score (DAS28-ESR), and they were subjected to high-frequency ultrasound both in greyscale and power Doppler.

Results: RA patients had lower AFR and higher CAR than those in the control group (P < 0.001). A positive correlation was demonstrated between CAR and DAS score (r=0.589, P = 0.0001), whilst there was a precise negative correlation between AFR and DAS 28-ESR (r=-0.74, p<0.001). ROC curve analyses revealed fibrinogen showed the best sensitivity (92.1%) for the area under the curve of 0.928, at a criterion of 2.47, while AFR has an area under the curve of 0.826 with sensitivity and specificity (86.84% and 75%, respectively) at cut-off value 1.46. Actively diseased patients had elevated CAR than those in remission (P < 0.001). Patients with synovial thickening and bone erosions had lower AFR than those without, CAR was higher in patients with power doppler changes than those without (p=0.015).

Conclusion: Higher CAR and lower AFR were expressed in active RA than those in remission. CAR and AFR could be useful markers of ongoing inflammation and joint affection detected by musculoskeletal ultrasonography.

Keywords: C-reactive protein; albumin-fibrinogen ratio; inflammation; rheumatoid arthritis; ultrasonography.

Grants and funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors received no financial support for the research, authorship, or publication of this article.