Boulos D, et al. - Researchers investigated the value of the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in identifying those who subsequently require escalation of disease modifying therapy because of continued disease activity in rheumatoid arthritis (RA). In the Early Arthritis Clinic at the Royal Adelaide Hospital, patients with newly diagnosed RA were provided “triple-therapy” with a standardised protocol of methotrexate, sulfasalazine and hydroxychloroquine, and were examined every three to six weeks. According to a pre-defined algorithm, adjustment of DMARD therapy was done if not in low disease activity. Failure of triple-therapy to maintain low-disease activity (DAS28<3.2) at 12 months was the primary outcome measure. Patients who subsequently fail triple-therapy for RA showed significantly increased NLR, and furthermore, NLR performed better than conventional markers in determining disease activity. These findings support NLR as an inexpensive, objective and reproducible prognostic marker in RA.