Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


The Relationship of Serum Cytokine Levels with Disease Activity Parameters and Ultrasonographic Findings in RA Patients before and after Treatment with TNF Antagonists.

Inanc2,  Nevsun, Bulur2,  Atilla, Can2,  Meryem, Ergonul1,  Onder, Atagunduz2,  Pamir, Yavuz2,  Sule, Direskeneli2,  Haner

Marmara University Medical School, Department of Infectious Diseases
Marmara University Medical School, Division of Rheumatology

Background:

Although effective in most patients, response to TNF antagonists is heterogenous and unpredictable in rheumatoid arthritis (RA). Bio-markers like serum cytokine levels or imaging methods like ultrasonography (US) might be helpful in predicting response to treatment with TNF-antagonists.

Methods:

Levels of IL1, IL1Ra, IL6, MCP, TNF, VEGF, IFN gamma, IL10, IL12, IL13 were measured by a Luminex multiplex technology, VEGF-R1 and ANG-1 by quantitative sandwich ELISA in 26 RA patients (72 samples) before and after TNF antagonist therapy at 3 and 6 months. Tender and swollen joint counts, ESR, CRP, DAS28, patient and physician's global assessment were recorded at each visit. US evaluation included GrayScale (0–3)(GS) and PowerDoppler (0–3)(PD) semiquantitative examination with a My Lab 70 XVG (Esaote Biomedica, Italy) equipped with 6–18 and 3–9 broad band linear transducer in 28 joints to calculate total GS and PD scores.

Results:

Mean (SD) age was 49(11) and disease duration 9.7(6.2) years. Mean DAS28(SD) score was 5.3(0.6) at baseline and 3.3(1.3) at 6 months' follow-up. The number of patients in remission was 2(8%) at 3 months and 9(35%) at 6 months' visit, respectively. Although levels of all selected cytokines decreased at 6 months' visit, only the changes at levels of MCP (p=0.009), IL10 (p=0.005) and IFNgamma (p=0.005) reached statistical significance. IL6 levels correlated with DAS28 at all visits (r=0.334, p=0.003). The baseline levels of VEGF, TNFalpha, IL6 and IL12 were found to be predictors of remission at 6 months according to DAS28 with an AUROC of 0.64 (95% confidence interval (CI) 0.4–0.9), 0.58 (95% CI: 0.4–0.8), 0.59 (95% CI: 0.4–0.8), 0.58 (95% CI: 0.3–0.8) respectively. Total GS score decreased significantly at both 3 (12.3±7.2)(p<0.001) and 6 months' visits (9.9± 6.6)(p<0.001) compared to the baseline visit (21.2±15.3). Similarly total PD score changes at both 3 (7.5±4.4)(p=0.001) and 6 months' visits (5.9±4.1) (p<0.001) differed significantly from the baseline (16.7±13.5). Total GS (r=0.402, p<0.001) and PD (0.455 p<0.001) scores correlated with DAS28 in all visits. However, only the levels of IL6 correlated with total GS (r=0.544, p=0.009) and total PD scores (r= 0.523, p=0.006) among the selected biomarkers.

Conclusion:

US findings and DAS28 correlated in all visits in our study, suggesting that both clinical and imaging follow-up is useful in monitoring RA patients before and after taking TNF antagonists. Although MCP, IFNgamma and IL10 serum levels decreased significantly at 6 months, IL6 seem to be the best cytokine for follow-up, correlating both with DAS28 and US findings. Baseline levels of VEGF, TNFalpha, IL6 and IL12 might also be appropriate for the prediction of remission during TNF antagonists.

To cite this abstract, please use the following information:
Inanc, Nevsun, Bulur, Atilla, Can, Meryem, Ergonul, Onder, Atagunduz, Pamir, Yavuz, Sule, et al; The Relationship of Serum Cytokine Levels with Disease Activity Parameters and Ultrasonographic Findings in RA Patients before and after Treatment with TNF Antagonists. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1133
DOI: 10.1002/art.28900

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