ArticleFrontiers in immunology2026
Evaluating disease activity scores and CBC-derived indices in relation to osteoporosis risk in rheumatoid arthritis: a cross-sectional analysis.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Osteoporosis (OP) is a frequent comorbidity in rheumatoid arthritis (RA). This study compared the performance of RA disease-activity scores with complete blood count (CBC)-derived indices for identifying prevalent OP. Methods: We retrospectively included 226 consecutive patients with RA who underwent dual-energy X-ray absorptiometry (DXA). Predictors comprised age, sex, body mass index (BMI), disease activity (DAS28-ESR, DAS28-CRP, CDAI, and SDAI), ESR, CRP, and six CBC-derived indices (NLR, PLR, MLR, SII, SIRI, and AISI). Logistic and linear regression, receiver-operating-characteristic (ROC) analysis with paired DeLong tests, decision curve analysis (DCA), and four-knot restricted cubic spline (RCS) analyses were performed. Results: Older age, female sex, lower BMI, and higher CDAI were associated with OP. The five-covariate clinical reference model had an AUC of 0.833. Adding CDAI increased the AUC to 0.892 (ΔAUC, 0.059; P = 0.005), and adding SDAI increased it to 0.877 (ΔAUC, 0.044; P = 0.018), although the ROC curves overlapped substantially. In parallel fully adjusted models, none of the six CBC-derived indices was independently associated with OP (all P≥0.142; apparent AUCs, 0.892-0.895). Adding CRP after DAS28-ESR changed the AUC from 0.863 to 0.869 (ΔAUC, 0.006; P = 0.491). In the extended discrimination model, adding any CBC-derived index changed the AUC by no more than 0.0014 (all P≥0.467). DCA showed small, threshold-dependent differences in net benefit rather than consistent separation between models. Four-knot RCS analyses showed evidence of nonlinearity for DAS28-ESR (P for nonlinearity=0.007) and SDAI (P for nonlinearity<0.001), but not for ln(AISI) (P for nonlinearity=0.391) or ln(SIRI) (P for nonlinearity=0.718). Conclusions: Disease-activity scores provided modest incremental discrimination beyond established clinical factors, whereas CBC-derived indices added little once conventional inflammatory and disease-activity information was included. These data do not support calculating CBC-derived indices solely to identify prevalent OP or using them as substitutes for guideline-based clinical risk assessment, FRAX, or DXA. The findings do not establish a new screening or treatment threshold.
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