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. 2025 Nov 24;23(1):121.
doi: 10.1186/s12969-025-01172-6.

Neutrophil lymphocyte ratio as a marker of skin disease activity in older children with juvenile dermatomyositis

Shreya Swaminathan  1 , Nidhi Naik  2 , Susan Shenoi  2 , Sarah Vandenbergen  3 , Jessica L Turnier  3 , Zilan Zheng  4 , Jessica Neely  4 , James S Andrews  5 , Christian Lood  6
Affiliations

Neutrophil lymphocyte ratio as a marker of skin disease activity in older children with juvenile dermatomyositis

Shreya Swaminathan et al. Pediatr Rheumatol Online J. .

Abstract

Background: Neutrophils contribute to the pathogenesis of many autoimmune diseases. While the neutrophil to lymphocyte ratio (NLR) is associated with disease activity in adult dermatomyositis, its clinical utility in juvenile dermatomyositis (JDM) is unknown.

Methods: Demographic, medication use, autoantibody profile, disease activity markers, and laboratory data from 97 JDM patients was collected using retrospective chart review. Patients were age-stratified (0–9 vs. 9–21 years of age), as white blood cell count stabilizes at 9 years. The relationships between NLR with JDM disease activity measures were analyzed using spearman’s correlation.

Results: Patients were primarily white (56.7%) and female (71.1%). Older children had lower physician global assessment (PGA) (2.0 vs. 4.0, p = 0.015) and lymphocyte count (1700 vs. 2320, p = 0.01), and higher manual muscle testing (MMT-8) (80 vs. 73, p < 0.001) and childhood myositis assessment score (CMAS) (49 vs. 45, p = 0.012). Cutaneous dermatomyositis disease area and severity index (CDASI) (r = 0.39, p = 0.007) and PGA skin (r = 0.52, p = 0.004) were associated with NLR in older children, independent on prednisone use. In younger children, skin involvement was negatively associated with NLR (r=-0.41, p = 0.024). No associations with muscle activity, including CMAS (r = 0.021, p = 0.91 vs. r = 0.25, p = 0.22), CK levels (r = 0.23, p = 0.11 vs. r=-0.041, p = 0.79), and MMT-8 (r = 0.152, p = 0.31 vs. r=-0.132, p = 0.377) were seen in older or younger children respectively.

Conclusions: Age-related variability in lymphocytes may complicate the interpretation and assessment of NLR in young children. NLR may serve as a cutaneous disease activity marker in older JDM patients. Larger multi-center cohorts are necessary to validate these findings and assess the role of treatment on NLR.

Keywords: Juvenile dermatomyositis; Neutrophil to lymphocyte ratio; Physician global assessment.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This multicenter retrospective cohort study was approved by the review boards at the University of Washington (UW), University of California San Francisco (UCSF), and University of Michigan (UM). Informed written consent was obtained from all participants according to the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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