Abstract Rationale Sarcoidosis is a granulomatous disease characterized by a complex interaction among inflammatory and immune cells; however, its exact cause remains unclear. Some patients exhibit serologic features of autoimmunity, such as antinuclear antibody (ANA) positivity, suggesting overlap with systemic autoimmune processes. The monocyte-to-lymphocyte ratio (MLR) is a simple marker of systemic inflammation that reflects the balance between innate (monocyte-driven) and adaptive (lymphocyte-mediated) immune activation. Because both ANA positivity and MLR represent distinct yet interconnected aspects of immune dysregulation, examining their relationship may provide insight into inflammatory patterns in sarcoidosis. This study examined patterns of MLR according to ANA status in patients with biopsy-confirmed sarcoidosis. Methods We conducted a retrospective review of 95 patients with biopsy-confirmed sarcoidosis who underwent serologic testing for autoimmune diseases. Laboratory data included absolute lymphocyte count (ALC), absolute monocyte count (AMC); MLR was calculated as ALC/AMC. Autoimmune markers included ANA, and other specific tests such as antineutrophil cytoplasmic antibody (ANCA), and rheumatoid factor (RF). Patients were stratified by ANA status. Differences in MLR between ANA groups were evaluated using the Mann-Whitney test, and the relationship between MLR and ANA titer was assessed using linear regression after log transformation of ANA titers in GraphPad Prism. Results The ANA-positive cohort (n = 60; 45 women and 15 men), included 21 patients with additional rheumatologic serologies. The ANA-negative cohort (n = 35; 28 women and 7 men) included one patient with isolated RF positivity. Mean ages were 57 years (ANA+) and 62 years (ANA-). The mean MLR was slightly higher in the ANA-positive group (3.1ms1 ±2.0)compared with the ANA-negative group (2.7ms2 ±1.2)When MLR was categorized as 4 or ≥ 4, a greater proportion of ANA-positive patients fell into the higher category (6.5% vs. 4.4%); (Figure 1a-b). There was a positive but non-significant association between ANA titer and MLR (p = 0.4), with higher ANA titers corresponding to higher MLR values (Figure 1c-d). Conclusion Sarcoidosis patients with autoimmune serologic features showed a trend toward higher monocyte-to-lymphocyte ratios compared with those without such features. This finding suggests a possible interplay between humoral autoimmunity and monocyte-driven inflammation. Further studies are warranted to validate these observations and determine whether this immune profile correlates with clinical manifestations or treatment response. This abstract is funded by: None
Okereke et al. (Fri,) studied this question.