Neutrophil–Lymphocyte Ratio in Fibromyalgia and Axial Spondyloarthritis: A Potential Biomarker for Diagnosis and Disease Activity

<b>Objective</b>: The Neutrophil–Lymphocyte Ratio (NLR) has been proposed as an inflammatory biomarker in several diseases, including Fibromyalgia, with controversial results. The objectives of this study were to: (1) compare NLR values among participants with Fibromyalgia, Axial Spondyl...

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Main Authors: Miriam Almirall, Esther Espartal, Xabier Michelena, Carlos Suso-Ribera, Mayte Serrat, Sara Marsal, Alba Erra
Format: Article
Language:English
Published: MDPI AG 2025-06-01
Series:Biomedicines
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Online Access:https://www.mdpi.com/2227-9059/13/6/1497
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author Miriam Almirall
Esther Espartal
Xabier Michelena
Carlos Suso-Ribera
Mayte Serrat
Sara Marsal
Alba Erra
author_facet Miriam Almirall
Esther Espartal
Xabier Michelena
Carlos Suso-Ribera
Mayte Serrat
Sara Marsal
Alba Erra
author_sort Miriam Almirall
collection DOAJ
description <b>Objective</b>: The Neutrophil–Lymphocyte Ratio (NLR) has been proposed as an inflammatory biomarker in several diseases, including Fibromyalgia, with controversial results. The objectives of this study were to: (1) compare NLR values among participants with Fibromyalgia, Axial Spondyloarthritis, and healthy controls; (2) assess the relationship between NLR and disease activity; and (3) establish diagnostic and activity cut-off values. <b>Methods</b>: A total of 112 age and gender-matched participants were included in each group. NLR values were compared between groups, correlations with disease activity were analyzed, and cut-off values were calculated using Receiver Operating Characteristic (ROC) curves. <b>Results</b>: The NLR was significantly higher in Fibromyalgia patients compared with healthy controls (1.8 ± 0.5 vs. 1.4 ± 0.2; <i>p</i> < 0.001) and in Axial Spondyloarthritis patients compared with both Fibromyalgia patients (2.1 ± 0.3 vs. 1.8 ± 0.5; <i>p</i> < 0.001) and healthy controls (2.1 ± 0.3 vs. 1.4 ± 0.2; <i>p</i> < 0.001). Within disease groups, the NLR was also significantly higher in patients with severe Fibromyalgia (FIQ ≥ 59) compared with non-severe cases (1.9 ± 0.5 vs. 1.7 ± 0.4; <i>p</i> = 0.008) and in patients with high/very high Axial Spondyloarthritis activity compared with those with low/inactive disease (2.3 ± 0.3 vs. 1.9 ± 0.2; <i>p</i> < 0.001). ROC analysis identified the NLR cut-off values of 1.54 for Fibromyalgia diagnosis, 1.64 for severe disease, 1.61 for Axial Spondyloarthritis diagnosis and 1.95 for high/very high disease activity. <b>Conclusions</b>: The NLR may serve as a cost-effective, rapid, and accessible biomarker for establishing diagnosis and disease activity in Axial Spondyloarthritis and, to a lesser extent, in Fibromyalgia. Further research is needed to validate these findings and explore NLR’s role alongside other inflammatory markers.
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spelling doaj-art-e2b9e10f835e40f5abbafd5743fdae212025-08-20T03:26:20ZengMDPI AGBiomedicines2227-90592025-06-01136149710.3390/biomedicines13061497Neutrophil–Lymphocyte Ratio in Fibromyalgia and Axial Spondyloarthritis: A Potential Biomarker for Diagnosis and Disease ActivityMiriam Almirall0Esther Espartal1Xabier Michelena2Carlos Suso-Ribera3Mayte Serrat4Sara Marsal5Alba Erra6Department of Rheumatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, SpainDepartment of Rheumatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, SpainDepartment of Rheumatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, SpainDepartment of Rheumatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, SpainDepartment of Rheumatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, SpainDepartment of Rheumatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, SpainDepartment of Rheumatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain<b>Objective</b>: The Neutrophil–Lymphocyte Ratio (NLR) has been proposed as an inflammatory biomarker in several diseases, including Fibromyalgia, with controversial results. The objectives of this study were to: (1) compare NLR values among participants with Fibromyalgia, Axial Spondyloarthritis, and healthy controls; (2) assess the relationship between NLR and disease activity; and (3) establish diagnostic and activity cut-off values. <b>Methods</b>: A total of 112 age and gender-matched participants were included in each group. NLR values were compared between groups, correlations with disease activity were analyzed, and cut-off values were calculated using Receiver Operating Characteristic (ROC) curves. <b>Results</b>: The NLR was significantly higher in Fibromyalgia patients compared with healthy controls (1.8 ± 0.5 vs. 1.4 ± 0.2; <i>p</i> < 0.001) and in Axial Spondyloarthritis patients compared with both Fibromyalgia patients (2.1 ± 0.3 vs. 1.8 ± 0.5; <i>p</i> < 0.001) and healthy controls (2.1 ± 0.3 vs. 1.4 ± 0.2; <i>p</i> < 0.001). Within disease groups, the NLR was also significantly higher in patients with severe Fibromyalgia (FIQ ≥ 59) compared with non-severe cases (1.9 ± 0.5 vs. 1.7 ± 0.4; <i>p</i> = 0.008) and in patients with high/very high Axial Spondyloarthritis activity compared with those with low/inactive disease (2.3 ± 0.3 vs. 1.9 ± 0.2; <i>p</i> < 0.001). ROC analysis identified the NLR cut-off values of 1.54 for Fibromyalgia diagnosis, 1.64 for severe disease, 1.61 for Axial Spondyloarthritis diagnosis and 1.95 for high/very high disease activity. <b>Conclusions</b>: The NLR may serve as a cost-effective, rapid, and accessible biomarker for establishing diagnosis and disease activity in Axial Spondyloarthritis and, to a lesser extent, in Fibromyalgia. Further research is needed to validate these findings and explore NLR’s role alongside other inflammatory markers.https://www.mdpi.com/2227-9059/13/6/1497Neutrophil–Lymphocyte RatioFibromyalgiaAxial Spondyloarthritisbiomarkerinflammation
spellingShingle Miriam Almirall
Esther Espartal
Xabier Michelena
Carlos Suso-Ribera
Mayte Serrat
Sara Marsal
Alba Erra
Neutrophil–Lymphocyte Ratio in Fibromyalgia and Axial Spondyloarthritis: A Potential Biomarker for Diagnosis and Disease Activity
Biomedicines
Neutrophil–Lymphocyte Ratio
Fibromyalgia
Axial Spondyloarthritis
biomarker
inflammation
title Neutrophil–Lymphocyte Ratio in Fibromyalgia and Axial Spondyloarthritis: A Potential Biomarker for Diagnosis and Disease Activity
title_full Neutrophil–Lymphocyte Ratio in Fibromyalgia and Axial Spondyloarthritis: A Potential Biomarker for Diagnosis and Disease Activity
title_fullStr Neutrophil–Lymphocyte Ratio in Fibromyalgia and Axial Spondyloarthritis: A Potential Biomarker for Diagnosis and Disease Activity
title_full_unstemmed Neutrophil–Lymphocyte Ratio in Fibromyalgia and Axial Spondyloarthritis: A Potential Biomarker for Diagnosis and Disease Activity
title_short Neutrophil–Lymphocyte Ratio in Fibromyalgia and Axial Spondyloarthritis: A Potential Biomarker for Diagnosis and Disease Activity
title_sort neutrophil lymphocyte ratio in fibromyalgia and axial spondyloarthritis a potential biomarker for diagnosis and disease activity
topic Neutrophil–Lymphocyte Ratio
Fibromyalgia
Axial Spondyloarthritis
biomarker
inflammation
url https://www.mdpi.com/2227-9059/13/6/1497
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