Red cell distribution width is a potential predictor of early relapse in polymyalgia rheumatica
Red blood cell distribution width (RDW) has been studied as a prognostic biomarker for different chronic inflammatory diseases. In this paper we aim to evaluate its potential role in the prediction of early relapse in patients affected by polymyalgia rheumatica (PMR). We revised retrospectively clinical records of patients who received a diagnosis of PMR, according to 2012 ACR/EULAR classification criteria, for whom baseline clinical and laboratory data were available. The baseline RDW variation coefficient was correlated to the risk of relapse, in the first 6 months of the disease. We identified 44 patients [females 15 (34.0%)/males 29 (66.0%); median age 80 (72-83)], 9 of whom had an early relapse. These patients showed a larger median RDW than patients who did not relapse [13.7 (13.5-14.9)% vs 13.5 (12.7-14.2)%; p=0.04). The two groups were comparable for all the other clinical and laboratory parameters considered. Interestingly, patients in the higher half of the RDW distribution showed a shorter relapse-free survival (p<0.03). In a stepwise logistic regression, RDW (p=0.01) predicted the risk of relapse at 6 months, while age, gender, CRP, ESR, Hb, MCV and prednisone dose did not fit the model. Our results show that RDW is an independent biomarker of early relapse, making this parameter a potentially promising predictive marker in PMR.
Hu ZD, Lippi G, Montagnana M. Diagnostic and prognostic value of red blood cell distribution width in sepsis: A narrative review. Clin Biochem. 2020; 77: 1-6. DOI: https://doi.org/10.1016/j.clinbiochem.2020.01.001
Tonelli M, Sacks F, Arnold M, et al.; for the Cholesterol and Recurrent Events (CARE) Trial Investigators. Relation Between Red Blood Cell Distribution Width and Cardiovascular Event Rate in People With Coronary Disease. Circulation. 2008; 117: 163-8. DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.727545
Patel KV, Ferrucci L, Ershler WB, et al. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med. 2009; 169: 515-23. DOI: https://doi.org/10.1001/archinternmed.2009.11
Zorlu A, Bektasoglu G, Guven FM, et al. Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism. Am J Cardiol. 2012; 109: 128-34. DOI: https://doi.org/10.1016/j.amjcard.2011.08.015
Zou XL, Lin XJ, Ni X, et al. Baseline red blood cell distribution width correlates with disease activity and therapeutic outcomes in patients with systemic lupus erythematosus, irrespective of anemia status. Clin Lab. 2016; 62: 1841-50. DOI: https://doi.org/10.7754/Clin.Lab.2016.160213
Hu ZD, Sun Y, Guo J, et al. Red blood cell distribution width and neutrophil/lymphocyte ratio are positively correlated with disease activity in primary Sjögren's syndrome. Clin Biochem. 2014; 47: 287-90. DOI: https://doi.org/10.1016/j.clinbiochem.2014.08.022
Yunchun L, Yue W, Jun FZ, et al. Clinical significance of red blood cell distribution width and inflammatory factors for the disease activity in rheumatoid arthritis. Clin Lab. 2016; 62: 2327-31. DOI: https://doi.org/10.7754/Clin.Lab.2016.160406
Bellan M, Giubertoni A, Piccinino C, et al. Red Cell Distribution Width and Platelet Count as Biomarkers of Pulmonary Arterial Hypertension in Patients with Connective Tissue Disorders. Dis Markers. 2019; 2019: 4981982. DOI: https://doi.org/10.1155/2019/4981982
Bellan M, Soddu D, Zecca E, et al. Association between red cell distribution width and response to methotrexate in rheumatoid arthritis. Reumatismo. 2020; 72: 16-20. DOI: https://doi.org/10.4081/reumatismo.2020.1243
Muratore F, Pazzola G, Pipitone N, Salvarani C. Recent advances in the diagnosis and treatment of polymyalgia rheumatica. Expert Rev Clin Immunol. 2016; 12: 1037-45. DOI: https://doi.org/10.1080/1744666X.2016.1178572
Dasgupta B, Cimmino MA, Maradit-Kremers H, et al. 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2012; 71: 484-92. DOI: https://doi.org/10.1016/j.ymed.2012.09.009
Hoffmann JJ, Nabbe KC, van den Broek NM. Effect of age and gender on reference intervals of red blood cell distribution width (RDW) and mean red cell volume (MCV). Clin Chem Lab Med. 2015; 53: 2015-9. DOI: https://doi.org/10.1515/cclm-2015-0155
Dejaco C, Singh YP, Perel P, et al. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2015; 74: 1799-807.
Bellan M, Boggio E, Sola D, Gibbin A, Gualerzi A, Favretto S, et al. Association between rheumatic diseases and cancer: results from a clinical practice cohort study. Intern Emerg Med. 2017; 12: 621-7. DOI: https://doi.org/10.1007/s11739-017-1626-8
Dejaco C, Singh YP, Perel P, Hutchings A, Camellino D, Mackie S, et al. Current evidence for therapeutic interventions and prognostic factors in polymyalgia rheumatica: a systematic literature review informing the 2015 European League Against Rheumatism/American College of Rheumatology recommendations for the management of polymyalgia rheumatica. Ann Rheum Dis. 2015; 74: 1808-17. DOI: https://doi.org/10.1136/annrheumdis-2015-207578
Nakamura H, Kamada K, Tarumi M, et al. Gadolinium-enhanced magnetic resonance imaging in shoulders contributes accurate diagnosis and predicting recurrence to patients with polymyalgia rheumatica. Clin Exp Rheumatol. 2020 Mar 28 [Epub ahead of print].
Hattori K, Hirano Y, Kojima T. Predictors of glucocorticoid-free remission in patients with polymyalgia rheumatica treated with prednisolone. Int J Rheum Dis. 2020; 23: 1581-6. DOI: https://doi.org/10.1111/1756-185X.13978
Birra D, Bosello SL, Peluso G, Zoli A. Sixth-month remission as a predictor for twelve-month remission in polymyalgia rheumatica. Clin Exp Rheumatol. 2020; 38: 436-41.
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