Pan-Immune Inflammation Value in Newly Diagnosed Rheumatoid Arthritis Patients Initiating Methotrexate Treatment

Abstract

Background: Rheumatoid arthritis (RA) is a persistent autoimmune condition characterized by synovial inflammation, culminating in joint deterioration and systemic implications. Methotrexate (MTX) is the primary therapeutic intervention for RA initiation due to its immunomodulatory properties. Nevertheless, resistance to MTX therapy is observed in a notable subset of patients. The Pan-Immune Inflammation Value (PIV) has recently emerged as a prospective biomarker in various inflammatory contexts, furnishing prognostic insights and indications of therapeutic response. Derived from routine complete blood count parameters, PIV has garnered significant interest as a prognostic biomarker across a spectrum of medical conditions, encompassing cancer to septic shock. Despite this, there exists a paucity of data regarding the efficacy of PIV as a prognostic biomarker for predicting treatment outcomes in newly diagnosed RA patients initiating MTX therapy. Objectives: This study aims to assess the potential utility of PIV as a prognostic biomarker in newly diagnosed RA patients undergoing MTX therapy. Additionally, the study explores the plausible correlation between PIV and the Disease Activity Score of 28 joints (DAS-28). Methods: A comprehensive analysis encompassing 64 RA patients, stratified into Methotrexate-resistant (MTXR) and Methotrexate-sensitive (MTXS) cohorts, along with 28 age- and sex-matched healthy individuals, was conducted. ANOVA analyses were employed to evaluate variations in hematological biomarkers among the groups. Standard T-tests facilitated the comparison of specific biomarkers among MTXR, MTXS, and control groups. The Chi-square test was utilized to compare categorical variables among the groups. Pearson's correlation test was also employed to explore correlations between PIV and DAS28 in both cohorts. Receiver Operating Characteristic (ROC) curve analysis was performed to ascertain the predictive capacity of PIV. Results: An unpaired t-test revealed no statistically significant difference in PIV (p=0.16) between the MTXR and MTXS groups. Similarly, no significant positive correlations were discerned between PIV and DAS-28 in the MTXR or MTXS groups (p=0.15 and 0.33, respectively). Furthermore, ROC curve analysis revealed insignificance in the predictive capability of PIV. Conclusions: Based on our findings, we cannot advocate for the utilization of PIV as a predictor of methotrexate response in newly diagnosed RA patients. Moreover, our study cohort underscores the inadequacy of PIV as a replacement for DAS-28 in assessing disease activity among RA patients.