Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Role of the Th17 Phenotypic Differentiation in the Persistence of Early Arthritis

Frati1,  Elena, De Stefano1,  Renato, Nargi1,  Fernando, Baldi1,  Caterina, Menza1,  Luana, Spreafico2,  Adriano, Chellini2,  Federico

Azienda Ospedaliera Universitaria Senese, Siena, Italy
U,O.C. Reumatologia, Siena, Italy

Purpose:

The prevalent phenotypic differentiation toward Th17 instead of the phenotypic differentiation toward the cells Treg may be a possible pathogenetic mechanism for a chronic inflammatory process, otherwise destined to the auto-resolution.

Method:

We conducted an investigation on a group of 57 patients with early arthritis to verify if the serum levels of cytokines, able to express a prevailing phenotypic differentiation of naive cells TCD4 + to the line Th17, may constitute potential biomarkers predictive of conversion of an early arthritis in early rheumatoid arthritis. All the patients, under basal conditions, were referred to a drawing of a blood sample stored immediately at -80°C to be subsequently used for determining, through a Bio-Plex Protein System, the serum level of IL-12, INFg, TGF-b, IL-17, IL-23, IL-6. After 6 months from the beginning of the arthritic symptoms, all the patients have been submitted to a new clinical, biohumoral and instrumental evaluation and they were inserted in 3 fundamental categories (auto-resolution, persistent idiopathic undifferentiated arthritis or rheumatoid arthritis, persistent differentiated arthritis not rheumatoid).

Results:

Serum levels of the various cytokines appear independent from the age of the patients and from the level of the clinical-biohumoral parameters of inflammation, such as VES, number of tender and swollen joints, the DAS28. In the group of patients with a persistent idiopathic undifferentiated arthritis, there is a statistically significant increase of serum levels of the IL-17, IL-6 and IL-23. There is a statistically significant correlation among the serum levels of the IL-17 and the serum levels of the IL-23 (r = 0.62, p = 0.0098) and among the serum levels of the IL-17 and serum levels IL-6 (r = 0.51, p = 0.039). In the group of patients with idiopathic persistent undifferentiated arthritis emerge 2 well separate subgroups. One group characterized by serological markers of autoimmunity, rheumatoid factor and anti-CCP, that show a significant increase in the serum levels of the IL-6, but also of the IL-17 and of the IL-23. The second group, seronegative, shows contrarily an increase of the serum levels of the IL-6, an increase of the Il-17 in smaller measure, while the serum levels of IL-23 are similar to those found in the patients with autorisolution of the arthritis.

Conclusion:

Results of our study would seem to point out that the prevailing phenotypic differentiation of the lymphocytes T-CD4 + toward the Th17 constitutes a pathogenetic line which is involved in the development of an idiopathic persistent undifferentiated arthritis, at least in those forms associated with the presence of biomarkers of autoimmunity such as rheumatoid factor and anti-CCP. In this group of patients, such phenotypic differentiation appears sustained by the IL-6 but especially by the IL-23.

To cite this abstract, please use the following information:
Frati, Elena, De Stefano, Renato, Nargi, Fernando, Baldi, Caterina, Menza, Luana, Spreafico, Adriano, et al; Role of the Th17 Phenotypic Differentiation in the Persistence of Early Arthritis [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1335
DOI: 10.1002/art.26409

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