Research ArticleArticle
Red Cell Distribution Width and Absolute Lymphocyte Count Associate With Biomarkers of Inflammation and Subsequent Mortality in Rheumatoid Arthritis
Alyssa Lange, Lenche Kostadinova, Sofi Damjanovska, Ibtissam Gad, Sameena Syed, Husna Siddiqui, Patrick Yousif, Corinne M. Kowal, Carey Shive, Christopher Burant, Nora Singer, Taissa Bej, Sadeer Al-Kindi, Brigid Wilson, Maya Mattar, David A. Zidar and Donald D. Anthony
The Journal of Rheumatology November 2022, jrheum.211411; DOI: https://doi.org/10.3899/jrheum.211411
Alyssa Lange
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
Lenche Kostadinova
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
Sofi Damjanovska
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
Ibtissam Gad
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
Sameena Syed
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
Husna Siddiqui
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
Patrick Yousif
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
Corinne M. Kowal
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
Carey Shive
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
Christopher Burant
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
Nora Singer
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
Taissa Bej
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
Sadeer Al-Kindi
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
Brigid Wilson
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
Maya Mattar
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
David A. Zidar
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
Donald D. Anthony
This study was supported by the U.S. Department of Veterans Affairs BX001894 (DDA), IK2CX001471 (CS), and CX001791 (DDA). A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University; C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University; N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University; D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA. A. Lange and L. Kostadinova contributed equally as first authors. D.A. Zidar and D.D. Anthony are co–senior authors. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. D. Anthony, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH 44106, USA. Email: dda3@case.edu. Accepted for publication August 9, 2022.
Abstract
Objective Morbidity and mortality in rheumatoid arthritis (RA) is partly mitigated by maintaining immune and hematologic homeostasis. Identification of those at risk is challenging. Red cell distribution width (RDW) and absolute lymphocyte count (ALC) associate with cardiovascular disease (CVD) and mortality in the general population, and with disease activity in RA. How these variables relate to inflammation and mortality in RA was investigated.
Methods In a retrospective single Veterans Affairs (VA) Rheumatology Clinic cohort of 327 patients with RA treated with methotrexate (MTX)+/- a tumor necrosis factor (TNF) inhibitor (TNFi), we evaluated RDW and ALC before and during therapy and in relation to subsequent mortality. Findings were validated in a national VA cohort (n = 13,914). In a subset of patients and controls, we evaluated inflammatory markers.
Results In the local cohort, high RDW and low ALC prior to MTX treatment was associated with subsequent mortality over 10 years (both P < 0.001). The highest mortality was observed in those with both high RDW and low ALC. This remained after adjusting for age and comorbidities and was validated in the national RA cohort. In the immunology cohort, soluble and cellular inflammatory markers were higher in patients with RA than in controls. ALC correlated with age, plasma TNF receptor II, natural killer HLA-DR mean fluorescence intensity, and CD4CM/CD8CM HLA-DR/CD38%, whereas RDW associated with age and ALC. MTX initiation was followed by an increase in RDW and a decrease in ALC. TNFi therapy added to MTX resulted in an increase in ALC.
Conclusion RDW and ALC before disease-modifying antirheumatic drug therapy are associated with biomarkers of monocyte/macrophage inflammation and subsequent mortality. The mechanistic linkage between TNF signaling and lymphopenia found here warrants further investigation.
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In this issue
The Journal of Rheumatology
Vol. 50, Issue 1
1 Jan 2023
Red Cell Distribution Width and Absolute Lymphocyte Count Associate With Biomarkers of Inflammation and Subsequent Mortality in Rheumatoid Arthritis
Alyssa Lange, Lenche Kostadinova, Sofi Damjanovska, Ibtissam Gad, Sameena Syed, Husna Siddiqui, Patrick Yousif, Corinne M. Kowal, Carey Shive, Christopher Burant, Nora Singer, Taissa Bej, Sadeer Al-Kindi, Brigid Wilson, Maya Mattar, David A. Zidar, Donald D. Anthony
The Journal of Rheumatology Nov 2022, jrheum.211411; DOI: 10.3899/jrheum.211411
Red Cell Distribution Width and Absolute Lymphocyte Count Associate With Biomarkers of Inflammation and Subsequent Mortality in Rheumatoid Arthritis
Alyssa Lange, Lenche Kostadinova, Sofi Damjanovska, Ibtissam Gad, Sameena Syed, Husna Siddiqui, Patrick Yousif, Corinne M. Kowal, Carey Shive, Christopher Burant, Nora Singer, Taissa Bej, Sadeer Al-Kindi, Brigid Wilson, Maya Mattar, David A. Zidar, Donald D. Anthony
The Journal of Rheumatology Nov 2022, jrheum.211411; DOI: 10.3899/jrheum.211411
