Volume 9 Supplement 2

6th European Workshop on Immune-Mediated Inflammatory Diseases

Open Access

Unique circulating cytokine profile of rheumatoid arthritis patients with nodules

  • Bridget Hodkinson1,
  • Pieter WA Meyer2,
  • Eustatius Musenge3,
  • Mahmood Ally4,
  • Ronlad Anderson2 and
  • Mohammed Tikly1
Journal of Translational Medicine20119(Suppl 2):P48

https://doi.org/10.1186/1479-5876-9-S2-P48

Published: 23 November 2011

Background

Immunohistochemical studies suggest that the rheumatoid nodule (RN) is a Th1 granuloma [1], with focal vasculitis [2], yet the pathogenesis remains unclear and little is known about circulating cytokines in these patients.

Objective

We measured circulating cytokines of DMARD-naïve early RA patients, and compared profiles of patients with RN to those without RN.

Methods

A cross-sectional cohort of 149 DMARD-naïve adults with early RA (symptom duration ≤ 2 years). Assessments included a smoking history, the presence of subcutaneous RN, the Simplified Disease Activity Index (SDAI), and X-rays scored using the modified Larsen method, Rheumatoid Factor (RF) and anti cyclic citrullinated peptides (aCCP) tests. Serum cytokines were measured using the Bio-Plex® suspension array system. Differences between patients with RN and those without RN were explored using univariate and multivariate techniques, correcting for SDAI by regression analysis.

Results

Of 149 patients (120 females), the majority were Black Africans (93%) and 34 (22.8%) had RN. Patients with RN were more likely to be males, but neither smoking history nor symptom duration was significantly different between the two groups. RN patients had severe RA with higher SDAI (p=0.04) and X-ray scores (p=0.004), and higher RF (p=0.005) and aCCP (p=0.04) titers. Cytokine profiles in the RN patients showed significant elevation of predominantly Th1 cytokines, with higher interferon-gamma (IFN-G) (p=0.05), interleukin (IL)-12 (p=0.02), and IL-2 (p=0.05). In addition, cytokines of macrophage (TNF-a, p=0.16) and fibroblast origin (IL-7, p=0.05 and vascular endothelial growth factor, p=0.03) were significantly higher in these patients. Multivariate analysis showed IL-7 (p<0.001) and IFN-G (p=0.001) to be independently significant.

Conclusion

DMARD-naïve early RA patients with RN have a unique serum cytokine profile, with significant elevation of predominantly Th1 and fibroblast cytokines.

Authors’ Affiliations

(1)
Chris Hani Baragwanath Hospital, University of the Witwatersrand
(2)
Medical Research Council Unit for Inflammation and Immunity, University of Pretoria and NHLS
(3)
Biostatistics and Epidemiology Division, School of Public Health, University of the Witwatersrand
(4)
Dept. of Internal Medicine, University of Pretoria

References

  1. Hessian PA, Highton J, Kean A: Cytokine profile of the rheumatoid nodule suggests that it is a Th1 granuloma. Arthritis Rheum. 2003, 48: 334-338. 10.1002/art.10776.View ArticlePubMedGoogle Scholar
  2. Mellbye OJ, Førre O, Mollnes TE: Immunopathology of subcutaneous rheumatoid nodules. Ann Rheum Dis. 1991, 50: 909-912. 10.1136/ard.50.12.909.PubMed CentralView ArticlePubMedGoogle Scholar

Copyright

© Hodkinson et al; licensee BioMed Central Ltd. 2011

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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