Cytokinin panel in rheumatoid arthritis and correlation with histological patterns of synovitis -- active type of disease.

Rheumatoid arthritis (RA) is a chronically inflammatory disease of the articular synovial, with severe, progressive and irreversible articular destruction. RA pathogeny implies an autoimmune mechanism, the role of cytokines resulting from the exaggerated production of some cytokines that act as pro-inflammatory agents, being directly responsible of certain symptoms and articular destructions, and/or inadequate inhibition of certain cytokines that act as anti-inflammatory agents.

OBJECTIVE

We want to determine certain pro-inflammatory cytokines (tumoral-alpha -- TNF-alpha necrosis factor, interleukin-6 - IL-6, interleukin-8 - IL-8), anti-inflammatory cytokines (interleukin-10 - IL-10) and immunomodulators (interleukin-2 - IL-2) in some RA patients serum at the active stage of the disease and correlation with histological patterns of synovitis -- active type of disease.

METHODS

The 37 patients have been grouped in stage I (9 patients), II (15 patients) and III (13 patients) according to the anatomical staging of the ARA (American Rheumatism Association), the serum levels of the cytokines being determined by ELISA technique. From the 37 patients clinical investigated only 12 were histopathological examined.

RESULTS

The serum levels of IL-2 have been found low in patients with RA in the active stage of the disease, the lowest values having been determined at the patients in the 3rd stage of the disease, who also have the highest values of pro-inflammatory cytokines. In the case of IL-10 the lowest values have been found at patients in the advanced stages of the disease. In the serum of RA patients with follicular synovitis TNF-alpha was a dominant cytokine compared to patients with diffuse disease, but the greatest serum level was found in patient with granulomatous synovitis. Concentrations of IL-6 and IL-2 were highest in the serum of RA patients with follicular synovitis in comparison to patients with diffuse synovitis and could distinguish RA patients with these two histological variants of the disease.

CONCLUSIONS

In the active stage of the disease the symptoms are a consequence of the interleukin pro and anti-inflammatory game: high serum levels of pro-inflammatory cytokines are accompanied by low serum levels of anti-inflammatory cytokines. Cytokines can be used as monitoring markers of the acutization period in RA, increase in serum levels of pro-inflammatory cytokines showing the progression from the inactive phase to a new period of activity of the disease. The association between distinct histological appearance of rheumatoid synovitis and serum cytokine profile and diverse clinical activity of disease seems to confirm its heterogeneity.