The Evaluation Study Of The IL-17in The Peripheral Blood, Disease Activity Index And Quality Of Life Among AS Patients With The Co-treatment Of Infliximab(Remicade) And MTX

ObjectiveTo evaluate (1) The effect on the expression of IL-17and the clinical indicators expressingthe disease activity index with co-treatment of Remicade and MTX among AS pati-ents;(2)The effect on the related cytokines with the IL-17such as:IL-23,TNF-α with co-tre-atmentamong AS patients;(3) The effect on the SF-36with co-treatment among AS patients.A-ndprovide the clinical evidence for the establishment of treatment project against AS in domes-ticrange.MethodsThe expression of IL-17A and IL-23before and after co-treatment of Remicade and MTXamong16patients with AS and16patients with sole treatment of Remicade were determinedby applying ELISA. The expression of TNF-αbefore and after treatment was also investigatedamong total of32subjects by using ELISA. RT-PCR was performed to determine the expressi-on of IL-17among10subjects with co-treatment and9subjects with sole treatment of Remic-ade.Results1. IL-17A level decreased significantly after the treatment with Remicade among patientswith AS（P<0.001）；the variation on the expression of IL-17A before and after treatment wasmore significant on the co-treatment group than Remicade group (P<0.01); the difference of jo-int tenderness index and BASDAI score were both showed significance between subjects withperipheral joints involvement in co-treatment group and subjects without peripheral joints invo-lvement in sole treatment group (P<0.01；P≦0.05）.2. The expression of IL-7A among patients with AS has been positively associated with en-thesis index, the time of morning stiffness, BASDAI score, ESR and CRP (n=64, P<0.01).3. The gene expression of IL-17decreased significantly after the treatment with Remicade among patients with AS（P<0.001）；the variation of IL-17expression in PBMCs before andafter treatment was more signif-icant when being compared with the corresponding figure ofRemicade group（P<0.01）； the expression of IL-17among patients with AS was positivelyassociated with joint swelling index, enthesis index, BASDAI score, ESR and CRP（n=38，P<0.05；P<0.01；P<0.05；P<0.01；P <0.001；P<0.05）；4. IL-23level decreased significantly after the treatment with Remicade among patients w-ith AS（P<0.001）；the difference in expression of IL-23before and after treatment was moresignificant on the co-treatment group than Remicade group (P<0.05）; the significance was ide-ntified on the expression of IL-23between subjects with peripheral joints involvement in co-tr-eatment group and subjects without peripheral joints involvement in sole treatment group. Theexpression of IL-23among patients with AS was positively associated with joint tenderness in-dex, joint swe-lling index, enthesis index, BASDAI score, the time of morning stiffness, ESRand CRP (n=64, P<0.01).5.The positive association between IL-23and IL-17A has been proved（n=64，P<0.001）;moreover, IL-17A was also associated with the level of TNF-α（n=32，P<0.01）;however, therewas no significant relation between IL-23and TNF-α（n=32，P>0.05）; the mRNA of IL-17was positively correlated with IL-23level among patients with AS（n=38，P<0.001）, however,it showed no association with TNF-α（n=38，P>0.05）；in the co-treatment group, the expressionof IL-23, IL-17A and IL-17were no significant associated（n=16，P>0.05；n=10，P>0.05）. Thesignificant association between IL-23and IL-17A was detected in Remicade group（n=16，P<0.01）；6.It has been proved that, the variation on RP, SF, MH, PCS and MCS were more significa-nt in co-treatment group than Remicade group(P <0.05）; as for RP, the significance between s-ubjects with peripheral joints involvement in co-treatment group and subjects without peripher-al joints involvement in sole treatment group was identified by statistical analysis.7. The inverse association between IL-17A,IL-23and PF, RP, BP, GH, VT, SF, RE, MH, P-CS, and MCS was detected among patients with AS（n=64，P <0.01or P<0.001）; similar rela-tionship was also maintained between IL-17mRNA and above-mentioned indicators（n=38，P<0.01）;8. PF among patients with AS was negatively correlated with joint tenderness index, joint swelling index, enthesis index, BASDAI, the time of morning stiffness, ESR and CRP (n=64，P<0.01）; these indicators were all inversely associated with BP（n=64，P<0.05or P<0.001）,GH（n=64，P <0.001）, VT（n=64，P<0.001）, MH（n=64，P <0.01）, PCS （n=64，P <0.001）and MCS（n=64，P<0.001）. In addition, PR was negatively associated with joint tendernessindex, enthesis index, BASDAI, the time of morning stiffness, ESR and CRP（n=64，P<0.01）,and RE was also maintained same correlation with above-mentioned indicators (n=64，P<0.05or P<0.001）.Conclusion1.Remicade can restrain the expression of IL-17and IL-23of the serum among patientswith AS.2. The reduction of IL-17was greater in co-treatment group than Remicade group.3. The reduction of IL-23level before and after treatment has been proved greater in co-tre-atment group when being compared with Remicade group.4. SF-36was served as the indicator of life qualify, and it was suggested that SF-36has sig-nificant higher in co-treatment group than Remicade group.5. The co-treatment of Remicade and MTX would be more effective in treating against AS,especially in the subjects with peripheral joints involvement.6. IL-17and IL-23may play important roles in the development and occurrence of AS, andalso involved with the advancement of AS; The Remicade may directly or indirectly inhibit theIL-23to down-regulate the IL-17; Moreover, IL-17and TNF-α were also closely involved in th-e development of AS.7. The treatment against AS should include the timely response of manifestation of diseaseand control of advancement, however, the more important thing is to maintain the health both inpsychological and physical aspects of patients with AS, and do not ignore the health educationand daily exercise.