title: Is there an association between the Expanded Disability Status Scale and inflammatory markers in multiple sclerosis?
abstract: BACKGROUND
  Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease characterized by inflammation of white matter in the central nervous system. It has been indicated that this inflammation causes increased levels of proinflammatory cytokines. Therefore, we aimed to evaluate if there is a possible association between inflammatory markers and the Expanded Disability Status Scale (EDSS) score in patients with MS.
  
  
  METHODS
  We reviewed the data of 127 patients (91 women and 36 men) who were retrospectively diagnosed as MS according to the revised Mc Donald's criteria who were seen at our facility between January 2007 and December 2012. Patients were divided into two groups according to EDSS score: Group 1, EDSS < 5; and Group 2, EDSS ≥ 5. The risk factors that were evaluated included age and sex of the patients, duration of MS, drugs, thyroid function tests, vitamin B12 levels, homocysteine levels, immunoglobulins (Ig) A, G, and M, rheumatoid factor, complement 3 and 4, antistreptolysin O, C reactive protein (CRP), white blood cell count, and neutrophile-lymphocyte ratio (NLR).
  
  
  RESULTS
  There was a statistically significant difference between the groups in terms of age, duration of the disease, drug received, Ig M, free T3, serum homocysteine levels, CRP, and NLR (p < 0.05). Pearson's correlation analysis showed a significant correlation between age, duration of MS, IgM, serum homocysteine levels, CRP, and NLR. According to the receiver operating characteristic curve analysis, IgM and NLR were discriminative factors in patients in Group 2.
  
  
  CONCLUSIONS
  According to this study, inflammation may have a role in the pathogenesis of MS and in patients with EDSS > 5. Additionally, NLR and CRP levels may be discriminative factors of adverse clinical outcomes.
authors.affiliation: Department of Neurology, Ankara Numune Education and Research Hospital, Ankara, Turkey. Electronic address: drisilguzel@gmail.com.
authors.forename: Isil
authors.initials: I
authors.lastname: Guzel
authors.affiliation: Department of Neurology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Semra
authors.initials: S
authors.lastname: Mungan
authors.affiliation: Department of Neurology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Zeynep Neşe
authors.initials: ZN
authors.lastname: Oztekin
authors.affiliation: Department of Neurology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Fikri
authors.initials: F
authors.lastname: Ak
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D006801:Humans; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D009504:Neutrophils; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D002097:C-Reactive Protein
keywords: expanded disability status scale; inflammation; multiple sclerosis