The immune profile of patients with rheumatoid arthritis during immunosuppresive therapy

Abstract

The aim of the work is to make a complex investigation of the efficiency of biological agents or/and conventional DMARD therapy presenting the evolution of the biomarkers from the pretreatment stage up to 24 weeks of therapy and establishing weather the is a correlation between these biomarkers. A number of 26 patients from 3 clinics in Bucharest (Romania), diagnosed with RA according to ACR criteria, were evaluated prospectively during 24 weeks of therapy with DMARD or/and biological agents. We evaluated IL-1, IL-6, IL-8, IL-17, TNF-alfa, TGF-beta, tDPD, MMP-3, COMP, ICAM1,CD40L, RF IgG, IgA, IgM, CCP, AKA at 0, 6 and 24 weeks of treatment. In this study were included patients who are over 18, are for the first time on this therapy or after 6 months of break and are not on corticosteroids. The entire group of patients was divided in subgroups A (patients under DMARD therapy), and subgroup В (patients under DMARD and biological agents). The RF IgG in the group unde biological agents and DMARD had a much significant decrease (p=0,0028), and after 24 weeks the mean value was in normal limits. DAS28 was more decreased in group В (group В DAS28=0,008, group A DAS28=0,015); CRP was statistically significant decreased in the entire group of patients(X2=5,991), sig=0,013. TNF-alfa was significantly decreased in the entire group of patients (x2=5,991), sig—0,013. ICAM 1 in the group В presented variations which were statistically significant (p=0,021). In the group A CD40L presented variations which were statistically significant (p=0,017). In the group A were significantly decreased MMP3 (p=0,049) and COMP (p=0,015), tDPD was modified in the entire group of patients (x2-5,991), sig=0,013. The parameters which are statistically significant modified during 24 weeks of therapy in the entire group of patients are: CRP, DAS28, TNF-alfa, tDPD. IL-1, IL-17, TGF-beta, ICAM1 had a biphase evolution, with an increase in values at 6 weeks and a decrease at 24 weeks. The TNF-alfa blockers produce a decrease of this cytokine and also a secondary decrease of IL-1 and IL-6 with an increase of TGF-beta. The decrease of MMP3 and tDPD in the group of patients treated with DMARD and biological agents shows that together these agents are more efficient in stopping the bone resorption and cartilage destruction. There is a correlation between rheumatoid factor and markers of inflammation included in DAS28. Low values of IL-17 where correlated with low values of AKA and CCP, and IL-8 in high values was correlated with tDPD. Biological agents along with conventional DMARD therapy are more efficient in control of inflammation and extraarticular complications evidenced through the important dicease in DAS28 and RF.