Dichotomy of Local Th1- and Systemic Th2/Th3-Dependent Types of Immune Response in Rheumatoid Arthritis

Biomarkers of activity of rheumatoid arthritis were analyzed in the blood serum and synovial fluid of affected joints in 84 patients. Significant differences between the serum and synovial fluid levels were revealed for 10 of 17 analyzed biomarkers; the levels of IgM and proinflammatory cytokines TNFα, IL-1β, IFNγ, and IL-6 were higher in the synovial fluid. The concentration of IL-10 in the synovial fluid was also elevated. In the peripheral blood, the content of antinuclear antibodies, circulating immune complexes, and cytokines IL-4 and TGF-β was elevated. These findings attest to the development of local Th1 type immune response in affected joints paralleled by compensatory elevation of immunosuppressive cytokine IL-10 and systemic Th2/Th3 type immune response (judging from peripheral blood parameters) in patients with rheumatoid arthritis.

Specific features of joint ultrasound study in patients with rheumatoid arthritis

Aim. To study the specific features of joint ultrasound readings in rheumatoid arthritis (RA) in relation to its duration. Subjects and methods. A total of 162 patients (mean age, 43.54±11.1 years) with a mean RA duration of 3.22±3.13 years were examined. Gray-scale ultrasound study (USS) of hand and ankle joints was performed using color Doppler energy imaging. Group 1 included 78 patients with a RA duration of less than 2 years; Group 2 consisted of 84 patients with a RA duration of more than 2 years. Results. Joint USS diagnosed osteochondral erosions twice more frequently than conventional radiography. 82% of the patients with RA were found to have synovitis; 77% had thickening of the synovial membrane (SM) with hypervascularization, the vascularization intensity scores of 2—3 being predominant; and 54% had tenosynovitis of the carpal extensor tendon. Effusion into the joint cavity, SM hypervascularization scores of 2—3, and tenosynovitis were most common in Group 1. SM thickening and osteochondral erosions were prevalent in Group 2. Conclusion. Joint USS revealed that angiogenesis and inflammation were dominant in the patients with a RA duration of less than 2 years and the proliferative-destructive processes were prevalent in those with a RA duration of more than 2 years. Identifying the predominance of pathophysiological processes in each specific patient with RA will be able to individualize therapy and to improve the prognosis of the disease.