Non-steroidal anti-inflammatory drugs in rheumatoid arthritis. Effects on clinical parameters and cellular immunity

Fourteen patients with classical or definite rheumatoid arthritis were studied for the effect of piroxicam treatment on clinical parameters and cellular immunity. The treatment caused reduced disease activity as assayed by an augmented grip strength, reduced total stiffness, reduced duration of morning stiffness and reduced Ritchies articular index. No effect of the treatment was observed on the percentages of T8 and T4 positive cells nor on the natural killer (NK) cell activity in the peripheral blood mononuclear cells. In contrast, the treatment led to a reduction in the total amount of rheumatoid factor. Since rheumatoid factor is mainly produced locally in the inflamed synovial membranes, our results suggest an effect of piroxicam on the immune system locally but not in the peripheral blood.

Effects of nonsteroidal antiinflammatory drugs on the immune network

The immune system is extremely complex. It comprises many different types of cells and their products. In patients with rheumatic diseases the immune system is activated and has disturbed regulation. It is also believed that immune reactions are involved in the pathogenesis of these disorders. Nonsteroidal antiinflammatory drugs (NSAID) have therapeutic effects on rheumatic diseases. These effects can all be explained by inhibition of prostaglandin production locally in the diseased joints, leading to reduced inflammation. Little or no effects on the number of circulating lymphocyte subpopulations or on peripheral blood mononuclear cell immune reactions can be seen after treatment of patients with rheumatoid arthritis (RA) with NSAID. The possibility, however, exists that immune reactions locally in the diseased joints are modulated by NSAID secondary to reduced prostaglandin production.

Autologous mixed lymphocyte reactions in rheumatoid arthritis. Characterization of stimulator cells and the recognition unit for autoantigens on the responder cells

Reduced lymphocyte responses were detected in the peripheral blood (PB) of patients with rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA) in the autologous mixed lymphocyte reaction (AMLR) using irradiated non-T cells as stimulator cells and T cells as responder cells. The AMLR responses of synovial tissue (ST) and of synovial fluid (SF) lymphocytes were normal. Dendritic cells both from the peripheral blood (PB), ST and SF were very potent stimulators in the AMLR and in vivo activated, HLA-DR positive T cells both from ST and SF were able to stimulate autologous PB T-cells in both RA and JRA patients. A rabbit antiserum produced against a fragment comprising the variable heavy (VH) chain region of an IgG3 human myeloma protein (Kup) reacted with peripheral blood T cells and inhibited the AMLR responses. Thus, VH antigens are integral parts of the T cell receptor for autologous HLA-DR (Ia) antigens.

In situ characterization of mononuclear cells in rheumatoid tissues, using monoclonal antibodies. No reduction of T8-positive cells or augmentation in T4-positive cells

The reactivity of monoclonal mouse anti-human antibodies specific for mononuclear cell surface antigens were studied by the indirect immunofluorescence technique in frozen synovial tissue sections from patients with rheumatoid arthritis (RA). Most of the proliferating synovial lining cells were positive for HLA-DR antigens and monocyte-specific antigens, since they reacted with the OKIa1 and OKM1. Cells positive for HLA-DR and monocyte antigens were also seen scattered or in small nests in the synovial stroma, probably representing synovial cells or monocytes/macrophages. Some of the HLA-DR-positive cells may also be B lymphocytes or activated T cells. Endothelial cells were also HLA-DR antigen-positive. Monoclonal antibodies with specificity for all T cells (OKT3), for helper/inducer cells (OKT4), and for suppressor/cytotoxic cells (OKT8) reacted with cells often located in follicle-like structures around vessels. Cells with the T4 phenotype tended to be located in the centre of the follicles, whereas the T8 positive cells were more peripherally situated. In most instances fewer cells were positive for the T8 than for the T4 marker. In some instances there was as many T8-positive cells as T4-positive cells. Complete lack of T-lymphocyte subpopulations was not seen.

Antibodies to and elevations of beta 2 microglobulin in the serum of ankylosing spondylitis patients

Antibodies to beta 2 microglobulin are found in systemic lupus erythematosus patients and are important in the lymphocytotoxic reactions of sera from such patients. In this study, beta 2 microglobulin antibodies were measured with the use of an enzyme-linked immunosorbent assay with purified beta 2 microglobulin antigen and peroxidase-labeled anti-human IgG or IgM. IgG antibodies to beta 2 microglobulin were found in 68% of 22 patients with ankylosing spondylitis. This incidence was higher than the 5% in 80 controls (P less than 0.01) and similar to the 71% incidence found in 35 patients with systemic lupus erythematosus. Eleven (27%) of 41 patients with rheumatoid arthritis had elevated levels of antibodies to beta 2 microglobulin (P less than 0.01). The mean antibody levels expressed in enzyme units were 0.125 for patients with ankylosing spondylitis, 0.157 for those with systemic lupus erythematosus, 0.101 for those with rheumatoid arthritis, and 0.067 for controls. IgM anti-beta 2 microglobulin was not significantly different from controls. A competitive binding assay with enzyme-labeled beta 2 microglobulin was used to determine serum beta 2 microglobulin. These values were also found to be elevated in 48% of patients in all 3 disease categories (P less than 0.01). Beta 2 microglobulin antibodies and serum beta 2 microglobulin did not correlate with each other, renal diseases or antinuclear antibodies in patients with systemic lupus erythematosus, with rheumatoid factor or severity of articular disease in patients with rheumatoid arthritis, or with peripheral arthritis or iritis in those with ankylosing spondylitis. Although antibodies to beta 2 microglobulin might reflect a general disturbance of immune regulation in patients with systemic lupus erythematosus, their presence in those with ankylosing spondylitis, a disease closely associated with a specific HLA allotype and not usually associated with formation of autoantibody, suggests that they might play a role in the pathogenesis of the latter disease.

Detection of T-lymphocyte subpopulation in the peripheral blood and the synovium of patients with rheumatoid arthritis and juvenile rheumatoid arthritis using monoclonal antibodies

Monoclonal antibodies with specificities for various human T-cell antigens were used in direct immunofluorescence to quantify the proportions of T lymphocytes with suppressor/cytotoxic-cell markers and with helper/inducer-cell markers and of T lymphocytes with HLA-DR antigens. Normal percentages of lymphocytes with suppressor/cytotoxic-cell markers were detected in the peripheral blood synovial fluid and synovial tissue lymphocytes from patients with juvenile rheumatoid arthritis (JRA) and rheumatoid arthritis (RA), respectively. Normal percentages of T lymphocytes with helper/inducer-cell markers were seen in the peripheral blood of RA and JRA patients and in the synovial tissues of RA patients. Slightly decreased percentages of cells with the helper/inducer-cell marker were detected in the synovial fluids of JRA patients. The proportions of HLA-DR-positive T lymphocytes were highly increased in the synovial fluid and synovial tissue, whereas the numbers of these cells in the peripheral blood were normal. No significant differences in T gamma cells were detected between peripheral blood, synovial fluid and synovial tissue of JRA patients or between peripheral blood and synovial tissue of RA patients.