Interleukin-17 level in rheumatoid arthritis patients and its relation to disease activity: a clinical and ultrasound study

Abd Elsamad I Elhewala,Alaa Abdel-Aziz Labeeb,Waleed A Mousa,Dalia Salah,Samar G Soliman

doi:10.4103/1110-161x.168164

Abd Elsamad I Elhewala, Alaa Abdel-Aziz Labeeb + Show 3 more

Open Access

https://doi.org/10.4103/1110-161x.168164

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Journal: Egyptian Rheumatology and Rehabilitation	Publication Date: Oct 1, 2015
Citations: 4	License type: CC BY 4.0

Affiliation: Menoufia University

Abstract

The aim of this study was to measure the level of interleukin-17A (IL-17A) in the serum and synovial fluid of patients with rheumatoid arthritis (RA) and its relation to disease activity. A total of 100 patients suffering from RA were chosen from the outpatient clinic, Department of Physical Medicine and Rehabilitation, Menoufia University Hospital. The patient group was divided into three subgroups — mild, moderate, and severe — according to the disease activity score. All patients were subjected to clinical, laboratory, and ultrasound evaluation and to measurement of IL-17A in the serum and synovial fluid by means of the enzyme-linked immunosorbent assay technique. Fifty healthy individuals were evaluated for IL-17A level in the blood, and served as the control group. The present study revealed an increase in serum (P = 3.1) and synovial fluid (P = 5.2) IL-17A levels in RA patients with increased disease activity. The ultrasound study showed an increase in serum IL-17A levels with increased erosion of the knee (P= 5.99) and wrist (P= 5.03). There was an increase in serum IL-17A with increased effusion of the knee (P = 22.6) and wrist (P = 33.3). There was an increase in serum IL-17A with increased synovial hypertrophy of the knee (P = 6.39), wrist (P = 12.23), and second metacarpophalangeal (MCP) (P = 53.34). Finally, there was an increase in the blood IL-17A level, dryness of the eye (P = 3.8), dryness of the mouth (P = 3.2), and number of subcutaneous nodules (P = 2.5). In our study; the mean serum and synovial IL-17A levels were found in high titers in patients with disease activity, and with extra-articular manifestations like dry eyes, dry mouth, and subcutaneous nodules. Also erosions, synovial hypertrophy, and effusions were found with significantly high titers of IL-17A, denoting its usefulness as a measurement tool for high disease activity and destruction. Also targeting IL-17A may be useful as a treatment option for aggressive disease and for rheumatoid patients with poor prognosis.

Highlights

Rheumatoid arthritis (RA) is a complex, chronic autoimmune disease characterized by an inflammatory infiltration of immune cells, in particular T cells, which represent ∼40% of the synovial cellular infiltration and participate in a number of inflammatory and destructive events, such as synovial hyperplasia, pannus setting, cartilage and bone erosion, and joint destruction [1,2].Various cells from the immune system and from the synovium are involved, and a panel of cytokines are produced, expressed, and become functionally active even in the early stages of RA [2]
Laboratory measurements were taken of erythrocyte sedimentation rate, complete blood count, C-reactive protein, rheumatoid factor, anticyclic citrullinated peptide, and IL-17A in the serum and synovial fluid [5] by means of the enzyme-linked immunosorbent assay (ELISA) technique [6]
Roşu et al [2] reported that simultaneous IL-17A assessment in serum and synovial fluid was valuable for defining activity

Summary

Introduction

Rheumatoid arthritis (RA) is a complex, chronic autoimmune disease characterized by an inflammatory infiltration of immune cells, in particular T cells, which represent ∼40% of the synovial cellular infiltration and participate in a number of inflammatory and destructive events, such as synovial hyperplasia, pannus setting, cartilage and bone erosion, and joint destruction [1,2].Various cells from the immune system and from the synovium are involved, and a panel of cytokines are produced, expressed, and become functionally active even in the early stages of RA [2]. IL-17 responds by stabilizing the mRNA of cytokines, enhancing the receptor expression, and increasing migration, chemokine gene expression, and invasiveness of synoviocytes, and contributes to disease chronicity by inhibiting synoviocyte apoptosis [3]. It enhances metalloprotease secretion, leading to cartilage damage. These properties support the combined inhibition of IL-17A and IL-17F to control RA inflammation and joint destruction [3]

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Conclusion