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Aim: Peripheral neuropathy is a frequent but often under-recognized extra-articular manifestation of rheumatoid arthritis (RA), frequently linked to chronic systemic inflammation. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a simple marker of systemic inflammatory burden. This study aimed to investigate the association between NLR and peripheral neuropathy in RA. Methods: This cross-sectional study included 230 RA patients. Peripheral neuropathy was identified through clinical evaluation and nerve conduction studies. Demographic and clinical data, serological status, disease activity [28-joint Disease Activity Score (DAS28)], inflammatory markers, and complete blood counts were obtained. NLR was calculated from absolute neutrophil and lymphocyte counts. Multivariable logistic regression was used to identify factors associated with peripheral neuropathy. Discriminatory performance of NLR was evaluated using receiver operating characteristic (ROC) curve analysis. Results: Peripheral neuropathy was present in 93 of 230 patients (40.4%). Patients with neuropathy exhibited significantly higher NLR compared with those without neuropathy (median 3.8 vs. 2.3; P < 0.001). In multivariable logistic regression adjusting for age, disease duration, disease activity (DAS28), C-reactive protein (CRP), serological status, and glucocorticoid use, elevated NLR remained independently associated with the presence of peripheral neuropathy [adjusted odds ratio (OR) = 1.92, 95% confidence interval (CI): 1.48–2.49; P < 0.001]. Other factors significantly associated with neuropathy included older age, longer disease duration, higher DAS28, and seropositive status. CRP and glucocorticoid use were not significantly associated with neuropathy in the adjusted model. In the overall cohort, the model including NLR demonstrated significantly improved discrimination for peripheral neuropathy compared with the base model without NLR, with the area under the ROC curve (AUC) increasing from 0.75 (95% CI: 0.69–0.81) to 0.83 (95% CI: 0.77–0.89) after including NLR (P < 0.001). Conclusions: Elevated NLR is independently associated with the presence of peripheral neuropathy in RA after adjustment for major confounders, and it demonstrates incremental discriminatory value for distinguishing neuropathy status in RA.