Immunologic Parameters for Disease Activity in Rheumatoid Arthritis

This study aimed to determine the correlation of disease activity of rheumatoid arthritis (RA) with Th۱۷/regulatory T cell (Treg) and Forkhead box protein ۳ (Foxp۳) cells ratio in patients under therapy with anti-tumor necrosis factor (TNF)-α. Totally, ۸۴ patients with RA and ۱۳ healthy controls were included in this case-control study. The patients were divided into four groups to receive only methotrexate (MTX) (n=۲۵), monotherapy (anti-TNF) (n=۱۸), and combined therapy (MTX+anti-TNF) (n=۲۶); however, one group received no medications (n=۱۵) and was regarded as a positive control. Other ۱۳ healthy controls that were considered negative controls were also enrolled in this study. Patients with RA were attending Basrah General Hospital, Rheumatology Unit, Biological Therapy Center for receiving anti-TNF therapy. Flow cytometry was used for measuring Treg/Foxp۳ and Th۱۷ markers, and the DAS-۲۸ score was utilized to measure RA disease activity. Anti-TNF inhibitors (e.g., infliximab and etanercept), as well as other inflammatory and hematological parameters (e.g., erythrocyte sedimentation rate, total white blood cells, lymphocytes, monocytes, and neutrophil counts), were also measured in this study. DAS-۲۸ as a disease activity score was significantly correlated with Th۱۷/Treg/Foxp۳ ratio and the Th۱۷ cells count. Statistically, Th۱۷/Treg/Foxp۳ ratio was not correlated with body mass index, morning stiffness, and duration of the disease. Th۱۷/Treg/Foxp۳ ratio correlated significantly with DAS-۲۸ as an RA disease activity. The lower Treg/Foxp۳ frequency led to the higher DAS score reflecting higher disease activity. In the combined therapy group, disease activity was found lower than that in other patient groups indicating the effect of this combination on the relationship between MTX and anti-TNF. This study demonstrated that the main advantage of this combined therapy in RA patients was the reversion of Th۱۷ cell expan­sion.

کلیدواژه ها:

Anti-TNF ، Etanercept ، immunotherapy ، Infliximab ، Rheumatoid arthritis ، Th۱۷/Treg/Foxp۳ ratio