Abstract
The aim of the work – to research the relationship between the dynamics of cytokine levels in the early period (the first 12 and 24 weeks) of pharmacotherapy for rheumatoid arthritis (RA) and long-term outcomes in patients with the disease.Material and methods. The analysis included 93 patients with early RA. The majority of patients were women (n=77), middle-aged (58 [49; 66] years), with an early stage of the disease (the duration of the disease is 7 [4–11.5] months), seropositive according to IgM rheumatoid factor and cyclic citrullinated peptide antibodies, who had high (59.7%) or moderate (38.8%) disease activity.The concentration of 27 cytokines in the blood serum was determined with the help of multiplex xMAP technology on the Bio-Plex array system analyzer (BIORAD, USA). Repeated clinical examination of patients was carried out after 6 years.Results. Patients who achieved remission/low disease activity SDAI after 6 years had a lower level of IL-6 (7.7 [7.4; 23.3]), IL-9 (13.5 [9.1; 18.9]) 12 weeks after the start of therapy; lower IL-9 level (12.6 [6.8; 16.2]) 24 weeks after the start of the treatment, compared with the group of patients with moderate and high inflammatory activity (23.5 [12.4; 69.5], 17.8 [15; 29] and 18.5 [14.2; 22.8] respectively).Findings. The assessment of the level of proinflammatory cytokines (IL-6, IL-17), immunoregulatory cytokine IL-9 allows to evaluate the activity of the disease more fully and identify a group of patients, who needs the therapy intensification.
Highlights
The majority of patients were women (n=77), middle-aged (58 [49; 66] years), with an early stage of the disease, seropositive according to IgM rheumatoid factor and cyclic citrullinated peptide antibodies, who had high (59.7%) or moderate (38.8%) disease activity
The concentration of 27 cytokines in the blood serum was determined with the help of multiplex xMAP technology on the Bio-Plex array system analyzer (BIORAD, USA)
Patients who achieved remission/low disease activity SDAI after 6 years had a lower level of IL-6 (7.7 [7.4; 23.3]), IL-9 (13.5 [9.1; 18.9]) 12 weeks after the start of therapy; lower IL-9 level (12.6 [6.8; 16.2]) 24 weeks after the start of the treatment, compared with the group of patients with moderate and high inflammatory activity (23.5 [12.4; 69.5], 17.8 [15; 29] and 18.5 [14.2; 22.8] respectively)
Summary
У больных, достигших ремиссии/низкой активности заболевания по SDAI через 6 лет, через 12 недель от начала терапии отмечались более низкие уровни ИЛ-6 (7,7 [7,4; 23,3]) и ИЛ-9 (13,5 [9,1; 18,9]) и через 24 недели от начала лечения – более низкий уровень ИЛ-9 (12,6 [6,8; 16,2]) по сравнению с группой пациентов с умеренной и высокой воспалительной активностью (23,5 [12,4; 69,5], 17,8 [15; 29] и 18,5 [14,2; 22,8] соответственно). В нашем предыдущем исследовании было показано, что среди пациентов с ранним РА (регистр «ОРЕЛ», исследование РЕМАРКА) [17, 18], у которых в дебюте заболевания использовалась интенсивная стратегия, основанная на применении высокой дозы метотрексата (МТ), а при недостаточном эффекте монотерапии МТ – комбинированная терапия МТ и ГИБП, через 6 лет ремиссия (или низкая активность) сохранялась у трети [19, 20].
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