Clinical Utility of C-Reactive Protein/Albumin Ratio and Albumin/Fibrinogen Ratio in Patients with Rheumatoid Arthritis

The albumin-to-fibrinogen ratio (AFR) and the C-reactive protein-to-albumin ratio (CAR) have been served as inflammatory markers. However, their roles in rheumatoid arthritis remain unclear. To evaluate the clinical significance of CRP/Albumin ratio and Albumin / Fibrinogen ratio in patients with rheumatoid arthritis as inflammatory markers and its relation to disease activity and severity. A total of 60 RA patients were included in this cross-sectional study together with 30 healthy controls. The inclusion criteria were fulfilling the American College of Rheumatology/European League Against Rheumatism 2010 RA classification criteria, being over 18 years and accepting to participate in the study. Demographic and clinical parameters including serum erythrocyte sedimentation rate (ESR), CRP, fibrinogen, albumin, CAR and AFR measurement were recorded. Disease activity was measured using Disease Activity Score 28 (DAS28). Sixty RA patients were included,58 (96%) were females and 2(3.3%) were males. their age ranged from 23 to 70 years, with mean ± SD (48.10±7.85), and their duration of disease ranged from 1 to 34 years, with mean ± SD (13.85±7.64) together with 30 age and sex matched as a control group. Group I: They were subdivided according to disease activity into three groups: Group Ia: patients with severe disease activity: included 24 RA patients whose DAS score >5.1. Group Ib: patients with moderate disease activity: included 29 RA patients whose DAS score >3.2 but ≤ 5.1. Group Ic: patients with mild disease activity: included 4 RA patients whose DAS score ≤ 3.2. The data demonstrated significantly higher levels of fibrinogen and CRP in RA patients, compared to control, significantly higher levels of fibrinogen, CRP, ESR, and CRP/Alb ratio were noticed in patients with active disease compared to the remission subgroup. CRP/Alb ratio was highly statistically significant increased while Albumin /fibrinogen ratio decreased in RA patient compared to controls. CRP/Alb ratio was positively correlated with CRP, ESR and DAS Score 28 while Albumin /fibrinogen ratio showed negative correlation with them. CRP/albumin ratio was increased in all RA patients in comparison to control group while Alb/fibrinogen ratio was decreased.