Albumin–Fibrinogen Ratio and C-Reactive Protein–Albumin Ratio as Markers of Disease Activity in Rheumatoid Arthritis: A Cross-Sectional Study

Dhruv Roopkishore Pathak

Albumin–Fibrinogen Ratio and C-Reactive Protein–Albumin Ratio as Markers of Disease Activity in Rheumatoid Arthritis: A Cross-Sectional Study

Author(s)	Dr. Dhruv Roopkishore Pathak
Country	India
Abstract	Background: Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease in which accurate assessment of disease activity is essential for treatment monitoring. Conventional inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have recognized limitations. The albumin–fibrinogen ratio (AFR) and CRP–albumin ratio (CAR) combine positive and negative acute-phase reactants and may provide complementary information about inflammatory burden. Objective: To evaluate AFR and CAR as markers of disease activity in patients with RA and to assess their association with the Disease Activity Score-28 (DAS28). Methods: This observational cross-sectional study was conducted in the Department of General Medicine at Jaipur Golden Hospital, Rohini, New Delhi. Forty-eight adults fulfilling the ACR/EULAR 2010 classification criteria for RA were included. Disease activity was assessed using DAS28-ESR, and participants were categorized into active disease or remission. Serum albumin, fibrinogen, CRP, ESR and hemoglobin were measured. AFR and CAR were calculated, and group comparisons, correlation analysis, multivariable logistic regression and receiver operating characteristic (ROC) analysis were performed. Results: Among 48 participants, 24 (50.0%) had active disease and 24 (50.0%) were in remission. AFR was significantly lower in active disease than in remission (8.63 ± 2.05 vs. 12.69 ± 2.92; p < 0.0001). CAR was significantly higher in active disease [median 0.36 (IQR 0.325–1.044)] than in remission [0.15 (IQR 0.032–0.329); p = 0.0006]. AFR showed a significant moderate negative correlation with DAS28 (r = −0.521, p = 0.0002), whereas CAR showed a significant positive correlation (r = 0.385, p = 0.007). For discrimination of active disease, AFR had an area under the ROC curve (AUC) of 0.875 (95% CI 0.779–0.971), with 87.5% sensitivity and 75.0% specificity at a cutoff of ≤11.1436. CAR had an AUC of 0.788 (95% CI 0.658–0.918). Conclusion: In this study population, lower AFR and higher CAR were associated with greater RA disease activity. Both ratios may serve as accessible adjunctive inflammatory indices alongside established clinical disease activity measures. The findings require confirmation in larger, longitudinal studies before routine use as independent disease-activity biomarkers.
Keywords	rheumatoid arthritis, albumin–fibrinogen ratio, CRP–albumin ratio, disease activity, DAS28, inflammation, biomarkers
Field	Medical / Pharmacy
Published In	Volume 8, Issue 5, September-October 2026
Published On	2026-10-03

View / Download PDF File

About IJFMR Fees & Payment Current Issue Publication Archive	Submit Research Paper Track Submission Status Publication Guidelines Publication Ethics Peer Review & Plagiarism	Join as a Reviewer Editors & Reviewers Reviewer Referral Program Get Reviewer Membership Certi.	Website/Journal Policies Usage Policy Content Policies Privacy Policy

Contact Us		+91-9687-828-838	editor@ijfmr.com

International Journal For Multidisciplinary Research

A Widely Indexed Open Access Peer Reviewed Multidisciplinary Bi-monthly Scholarly International Journal

Albumin–Fibrinogen Ratio and C-Reactive Protein–Albumin Ratio as Markers of Disease Activity in Rheumatoid Arthritis: A Cross-Sectional Study

Share this