Analysis Of Serum Th1/Th2 Cytokines In Children With Non-systemic Onset Juvenile Idiopathic Arthritis

Background:Juvenile idiopathic arthritis is a group of chronic system auto immune disease that occurs in children under the age of 16 symptoms persist for more than 6 weeks,and the exclusion of other causes of arthritis,is one of the common childhood rheumatic diseases.At present,the cause is not completely clear,but the disease can be deformed,disability,serious can endanger the lives of children.The present study found that the imbalance of cytokine network play an important role in the occurrence and development of disease.However,clinical study of cytokines present on non systemic juvenile idiopathic arthritis is less.ObjectiveTo study the cytokine profile of non-SOJIA can help to clarify the pathogenesis,clinical classification and treatment of the disease.Method:All 41 children with non-SOJIA hospitalized to Children’s Hospital of Zhejiang University School of Medicine during Nov,2012 and Mar,2015 were enrolled(non-SOJIA,n=41),including polyarthritis(n= 11),oligoarthritis(n=10),enthesitis related JIA(ERA,n=20),and at the same time,85 cases of SOJIA were collected.Serum levels of Thl/Th2 cytokines IL-2,IL-4,IL-6,IL-10,TNF-α or IFN-γ)were measured by flow cytometry in patients with non-SOJIA or healthy children(control,n=202).The levels of Thl/Th2 cytokines and the correlation of cytokines with ESR or CRP were analyzed.Results:Compared to control,serum levels of IL-2,IL-6 or IFN-y were significantly increased in patients with non-SOJIA(2.9 vs 2.6 pg/ml,10.2 vs 6.4 pg/ml,6.3 vs 5.1 pg/ml respectively,all P<0.05),levels of TNF-a or IL-10 were significantly decreased(2.7 vs 3.9 pg/ml,2.8 vs7.1 pg/ml respectively,all P =0.000).Compared to SOJIA,serum levels of IL-6,IL-10 were significantly decreased in patients with non-SOJIA(9.9 vs 33.5 pg/ml,2.9 vs 4.1 pg/ml,both P=0.000),levels of IL-4 or IL-10 were significantly increased(3.1 vs 2.3 pg/ml,6.3 vs 4.4 pg/ml,both P<0.05).There were higher levels of IL-6 in patients with polyarthritis or ERA compared to oligoarthritis(12.7,11.0 vs 4.2,both P<0.05).Positive correlation of IL-6 or TNF-a level with C-reactive protein was observed in patients with ERA.When the IL-10 is less than or equal to 4.35pg/ml,non-SOJIA diagnostic sensitivity is 0.94.1 and the specificity is 0.811.When IL-6 was greater than or equal to 9.75pg/ml,the sensitivity is 0.541 and the specificity is 0.881.When IFN-ywas more than or equal to 6.9pg/ml,the sensitivity was 0.486,and the specificity was 0.881.Conclusion:Although there was relatively lower levels of IL-6 or IL-10 in children with non-SOJIA compared to SOJIA,Thl/Th2 imbalance and Thl predominance with higher IL-6 or IFN-y but lower serum TNF-a or IL-10 levels was existed in non-SOJIA children compared control.Polyarthritis or ERA had higher levels of IL-6 compared to oligoarthritis.