Accepted for/Published in: JMIR Research Protocols
Date Submitted: Jan 29, 2025
Date Accepted: Sep 15, 2025
Platelet indices as unequivocal markers of active disease in patients of non-radiographic axial Spondyloarthritis: Protocol for a cross-sectional study
ABSTRACT
Background:
Spondyloarthritis (SpA) is divided into axial and peripheral subtypes. The axial subtype further consists of ankylosing spondylitis (AS) or radiographic axial SpA (r-axSpA) and non-radiographic axial Spondyloarthritis (nr-axSpA). Though AS and nr-axSpA share some common features, nr-axSpA lacks x-ray-based sacroiliitis as defined by modified New York criteria i.e. presence of either bilateral grade 2 sacroiliitis or unilateral grade 3 sacroiliitis which is present in AS. Disease activity in either of them is measured via CRP (C-reactive protein) levels or MRI (Magnetic Resonance imaging) imaging of the pelvis showing sacroiliitis by presence of bone marrow edema. A person with active disease can have normal CRP and/or MRI findings, especially in nr-axSpA. Immune system activation during inflammation has been shown to alter the platelet maturation and morphology reflected by platelet indices. These platelet indices have been studied in the past in various autoimmune diseases like Psoriatic arthritis, Ankylosing spondylitis, Rheumatoid arthritis etc, and correlate with disease activity. In spondyloarthritis particularly, platelet indices have shown to be more central to the pathology of sacroiliitis and CRP that is currently used is majorly a generalized marker of inflammation. Hence, use of platelet indices can provide a better picture of inflammation, especially in patients with sacroiliitis. This study aims to further investigate if these platelet indices can be better markers of inflammation in nr-axSpA.
Objective:
In this study, we will determine if platelet indices are reliable biomarkers in measuring disease activity in patients with non-radiological Axial Spondyloarthritis.
Methods:
All patients classified as Axial Spondyloarthritis as per ASAS Criteria will be included in this study. Patients will be divided into two case groups: patients without radiographic sacroiliitis as non-radiographic axial Spondyloarthritis(nr-axSpA), with radiographic sacroiliitis as Ankylosing spondylitis(AS) as group A and case group B respectively, and normal individuals will be kept as controls to compare and correlate the platelet indices such as platelet count, platelet crit, mean platelet volume and platelet distribution width with CRP (C-reactive protein), ESR (Erythrocyte sedimentation rate) and MRI (Magnetic resonance imaging) findings of AS with nr-axSpA.
Results:
This is a non-funded study. The data collection started on 01st February 2025 and we expect to complete the study by December 2027. As of July 2025, 7 individuals have been enrolled in cases group A and B respectively, 5 individuals included in control group. At the end of study we would be able to correlate if platelet indices are trustable biomarkers of active disease in patients of nr-axSpA.
Conclusions:
If platelet indices prove to be better markers of active disease in nr-AxSpA then there exists a gap in clinical practice and these markers should be included in routine evaluation. Clinical Trial: Ref/2024/03/080100
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