Jui‐Chia Chang

Objectives: Evidence indicates that hematological indices, such as neutrophil‐to‐lymphocyte ratio (NLR), systemic immune‐inflammation index (SII), and neutrophil‐to‐hemoglobin and lymphocyte (NHL), are valuable for assessing disease activity in rheumatoid arthritis (RA). This study investigated their potential as biomarkers for monitoring treatment response and disease improvement in RA patients receiving biological and targeted synthetic disease‐modifying antirheumatic drugs (b/tsDMARDs). Methods: A retrospective analysis was conducted on 308 active RA patients receiving IL‐6 receptor inhibitors, TNF‐alpha inhibitors, cytotoxic T lymphocyte‐associated antigen‐4‐Ig (abatacept), or Janus kinase inhibitors. Hematological indices were collected at baseline and 6 months post‐treatment. Results: Significant reductions in NLR, SII, and NHL were observed after initiation of b/tsDMARD therapy. These changes correlated with improvements in DAS28‐ESR and discriminated good/moderate responders from non‐responders. Each index predicted a > 1.2‐point reduction in DAS28‐ESR (area under the curve values ranging from 0.709 for NHL to 0.732 for SII). Adding any of these hematological indices to ESR increased sensitivity to 62.0%–63.4% versus 53.4% for ESR alone. Among patients with active disease but normal ESR/CRP, these indices (sensitivity 54.8%–66.1%) better reflected disease burden and treatment response than traditional markers (sensitivity 29.0%), which changed minimally despite DAS28‐ESR improvement. Conclusion: NLR, SII, and NHL are potential biomarkers for assessing treatment response in RA patients receiving b/tsDMARDs. Used alongside ESR, these indices improve evaluation of disease improvement. Notably, in clinically active patients with normal ESR/CRP levels, these indices captured treatment‐related change that traditional acute‐phase reactants did not, supporting their use as alternative or complementary response indicators in this setting.

Recombinant human thyrotropin (rhTSH) can be used to enhance radioiodine therapy for shrinking multinodular goitre. The aim of this meta-analysis was to compare the effectiveness of rhTSH pretreatment and radioiodine therapy with that of radioiodine alone for treating benign nodular goitre. The PubMed, EMBASE, Cochrane Library, Scopus and ClinicalTrials.gov databases were searched to identify studies published before September 2014. A meta-analysis was performed to calculate the pooled effect size using random-effects models. The primary outcome was the reduction in thyroid volume. Secondary outcomes included thyroid function, extent of tracheal compression, radioactive iodine uptake, incidence of hypothyroidism and other complications. Nine RCTs including 416 patients were selected. The reductions in thyroid volume were significantly greater in the rhTSH pretreatment groups than those in the radioiodine alone groups at 12 months (weighted mean difference: 14·42%; 95% CI: 4·51-24·34% in high-dose rhTSH vs radioiodine alone; weighted mean difference: 19·66%; 95% CI: 3·67-35·65% in low-dose rhTSH vs radioiodine alone). The incidence of hypothyroidism in the high-dose rhTSH groups was significantly higher than that in the radioiodine alone groups. No significant difference in the incidence of hypothyroidism occurred between the low-dose rhTSH groups and the radioiodine alone groups. The overall results indicated that using rhTSH before radioiodine therapy resulted in a greater thyroid volume reduction than radioiodine therapy alone. An increased incidence of hypothyroidism was observed in patients receiving high-dose rhTSH. Low-dose rhTSH before radioiodine therapy is more efficacious than radioiodine therapy alone for treating nontoxic benign thyroid nodules.