Monocyte-high density lipoprotein, neutrophil-lymphocyte and lymphocyte-monocyte ratios in primary fibromyalgia patients: a possible relation with disease activity and depression

Abstract

Background
Systemic inflammation may contribute to fibromyalgia etiology. Novel inflammatory indices like monocyte-to-high-density lipoprotein ratio, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio have emerged as potential biomarkers, yet their relationship with fibromyalgia severity and depression remains under investigation. This study’s objective was to evaluate these ratios in fibromyalgia patients versus healthy controls and assess their association with disease activity, pain intensity, and depression.


Methodology
This case-control study enrolled 130 fibromyalgia patients who met the 2016 ACR criteria plus 130 age-matched healthy female controls. The Widespread Pain Index, Symptom Severity Score, Fibromyalgia Impact Questionnaire, Visual Analog Scale for pain, and Beck Depression Inventory, were all evaluated. Complete blood counts and lipid profiles were obtained to calculate inflammatory ratios.


Results

Fibromyalgia patients exhibited significantly higher monocyte-to-high-density lipoprotein ratio (0.015 ± 0.038 vs. 0.007 ± 0.020;
p
 < 0.001) and lower lymphocyte-to-monocyte ratio (6.74 ± 2.20 vs. 8.44 ± 1.72;
p
 < 0.001) compared to controls, while neutrophil-to-lymphocyte ratio exhibited insignificant difference. Monocyte-to-high-density lipoprotein ratio demonstrated a robust positive association with Beck Depression Inventory (
r
 = 0.995;
p
 < 0.001) and was identified as an independent predictor for Fibromyalgia Impact Questionnaire (β = 0.298;
p
 = 0.001). Conversely, lymphocyte-to-monocyte ratio was an independent predictor for pain severity (β = 0.166;
p
 = 0.048). ROC analysis showed moderate discriminatory capacity for monocyte-to-high-density lipoprotein (AUC = 0.762) and lymphocyte-to-monocyte ratio (AUC = 0.738).



Conclusions
Monocyte-to-high-density lipoprotein and lymphocyte-to-monocyte ratios are significantly altered in fibromyalgia and correlate with disease severity and depression. These readily available indices may serve as cost-effective biomarkers for monitoring fibromyalgia activity and psychological comorbidities.