NLRatio

[Brychni]

Neutrophil highLymphocytes low

Divide top by bottom and you get NLRatio.

Mine is high at 11

Does anyone else have this?

[StriatedCaracara]

I get this too. I read somewhere that more than 4.78 was high. If I plot a graph of N to L ratio over time the peaks match flares, and the worse the flare the higher the peak.

I mentioned this when I had my local NHS referral that failed. The rheumatologist only had my high ANA, no other immunological criteria met and even ESR not raised.

His response was they did not use N to L ratio.

I was flabbergasted as there was an obvious pattern.

I think some drug treatments alter levels too, one way or the other, for one or both, so for those being so treated, this can't be used so easily as a measure.

My argument would be in cases where this was not the case it could be very useful.

Here is a post I did on Lupus UK forum with links maybe supporting its consideration.

healthunlocked.com/lupusuk/...

I guess some doctors do use this measure informally.

[Brychni in reply to StriatedCaracara]

Hi there

Mine were 7.7/0.7 = 11 which is very high.

A possible explanation is that I am tapering prednisolone at the moment and at the time of the blood test had just reduced to 10mg from 15mg. when googling I see that steroids do increase NLR. However, throughout my intesive reading of info on this subject, I read, somehwere that it applies to steroid 'abuse'. Not sure that 15mg can be classed as steroid abuse! However, couldn't get anything more detailed about that particular possible cause.

I'm taking pred because my feet got suddenly so bad I went to GP asking about crutches. While exploring painkilling possibilities I remembered about my stash of prednisolone which rheumatology have said I can take when things are unbearable. Started immediately I got home and they literally started working by the followin morning. Had the rheumatology appointment on 10th and she put me back on methotrexate and the requisite blood tests showed the high NLR. No one has mentioned it. I saw this result while at the GP on the screen so it's possible that I will get a letter if there is anything further. It's also possible that this high NLR is the result of the sudden surge of worsening symptoms in my feet.

Still: it's yet another 'vague' but possibly serious thing I need to worry about along with the Pm-scl 100 antibody which led to the lung function test which showed low MMEF that the rheumatologist is waiting for information about. Still waiting for the echocardiogram appointment (pm scl 100).

[StriatedCaracara in reply to Brychni]

I think it is a flare, not sure steroid you took would do this on its own. Your GP might know patterns seen, and may be shed light on it and discuss a bit.My GP helped me when got some extra bloods done once. Was a good chat, unexpected but very helpful.

[Brychni in reply to StriatedCaracara]

The bloods were taken on 10th at rheumatology in order for me to start methotrexate. I asked about the results when I was at the GP to discuss Shared Care (rehumatology had forgotten to send after initiating prescription}. GP printed them off for me and as she was doing so I said outloud 'Oh, high neutrophils, low lymphocytes - I wonder what that means?' and she didn't say a word.

And wth regard to the MMEF (FEF 25/75) thing - the rheumatologist told me she had googled it 🙄. She didn't say what she had learned!

I find it all really frustrating. I worry, a lot. It seems that every time I have a test for one thing it shows something else and no one tells me anything. It's not the first time.

Is it possible to have a flare up just in feet?

[StriatedCaracara]

I think there might be various reasons.

My highest was only 7.5, that was before I started hydroxychloroquine.

Then since treated successfully only got smaller increases when I flared.

So think it is immune response being impacted overall causing increase in neutrophils and decrease in lymphocytes.

For me, I wondered if it was affecting nerves and antiphospholipid?

You also mention lungs..that will impact too maybe.

Hope you find the right person to get answers from soon 🙏

[Brychni in reply to StriatedCaracara]

Yes, I have the antibeta2 glycoprotein 1 antibody too.

pm scl 100, sinuvitis, Raynauds and low platelets - although not at the moment: they were 188 and a quick google confirms that prednisolone treats thrombocytoipaenia really effectively so they will probably go down again when I come off the pred.

[StriatedCaracara in reply to Brychni]

A paper on anti lymphoctye antibodies..

pmc.ncbi.nlm.nih.gov/articl...

[StriatedCaracara]

I feel increasingly that research needs for categorising and scoring patients determine criteria, pathways, tests and markers referred to and the scope of what many discuss...not specific patient needs.

The more I have spoken up about this with doctors, not standing back, the more honesty I have found, and that discussions are worth it sometimes ...although so tiring. It is such a battle. Occasionally they show they agree..

For me N:L ratio is the best reflection of how I feel.

[StriatedCaracara]

More broadly regarding choice of measures I found this very recent video by Dr Donald Thomas, author of The Lupus Encyclopedia, very insightful:

healthunlocked.com/lupusuk/...

[Brychni in reply to StriatedCaracara]

this is going to be interesting watch - I don't know when my next rheum appointment will be but I am going to have to get better at asking more questions!

[Brychni]

thank you for the links. This is the first time in all the blood tests I have had that I have had this NLR - or indeed one or the other (high or low) it's always been low platelets and occasionallly low white blood cells.

[StriatedCaracara in reply to Brychni]

There should be more research to understand it all..

Maybe looking at broader cohorts of patients ..