| Objective: Rheumatoid arthritis(RA) is a systemic autoimmune diseaseas the main feature of erosive arthritis. The pathogenic mechanism of RA hasnot been fully elucidated. Many cytokines are considered to play importantroles in the pathogenesis of RA. Currently, many researchers have observedthat tumor necrosis factor superfamily is involved in the development of RA.Tumor necrosis factor-like ligand1A(TL1A) plays a very important role in theactivation of immune cells and the release of corresponding cytokines andother aspects. TL1A can enhance the differentiation and proliferation of Th17cells and Th1cells, and promote the secretion of interleukine-17(IL-17) andTNF-α. The aim of this study was to assess the level and clinical significanceof TL1A in RA through detecting the serum and synovial fluid levels of TL1A,IL-17and TNF-α.Methods: Thirty RA patients were chosen, of all whom were consistentwith American Rheumatism Institute and European congress preventionfederation rheumatoid arthritis diagnostic criteria of2009. All patients werepreviously untreated with glucocorticoid(GC), disease modifyingantirheumatic drug(DMARD) and biologic agent. According to the results ofrheumatoid factor(RF), RA serum group was divided to RF+/RA group of21cases and RF-/RA group of9cases; RA synovial fluid group was divided toRF+/RA group of10cases and RF-/RA group of5cases. Twenty OA patientswere chosen. All patients were previously untreated with anti-inflammatoryand analgesic drugs, disease modifying osteoarthritis drugs(DMOAD)andcartilage protection drugs, of all whom were consistent with AmericanRheumatism Institute osteoarthritis diagnostic criteria of1995. Twenty healthypeople as control were chosen. Serum was taken from all the RA patients, OApatients and normal controls; synovial fluid was taken from15cases RA patients. Clinic indexes of patients with rheumatoid arthritis were recordedsuch as age, gender, disease duration, swollen joint count, tender joint count,ESR, CRP, RF, DAS28, etc. Avidin biotin peroxidase complex enzyme-linkedimmunosorbent assay (ABC-ELISA) was used to measure the serum TL1Alevels of RA patients, OA patients and healthy people and the synovial fluidTL1A levels of15patients with RA. Serum TL1A was compared among RAgroup, OA group and normal group; TL1A, IL-17and TNF-α wererespectively compared between RA serum group and RA synovial fluid group;TL1A was respectively compared between RF+/RA serum and synovial fluidgroup and RF-/RA serum and synovial fluid group. The correlationcoefficients were respectively analyzed TL1A, IL-17and TNF-α in RA serumand synovial fluid group. The correlation coefficients were respectivelyanalyzed between the TL1A and the clinical parameters (swollen joint count,tender joint count, ESR, CRP, RF, DAS28) in RA serum and synovial fluidgroup.All the data were analyzed by statistical software SPSS17.0for windows.The mean number±standard deviation (x±s) was used to express themeasurement data. The t test was adopted for comparison between groups.Analysis of variance was used for the comparison among groups. Linearcorrelation analysis was performed for correlationship. P value<0.05wasconsidered significant.Results:1General data description: The serum group of30RA patients, the mean agewas (44.77±14.48) yr, and20subjects were female,10subjects were male.The course of the disease was from1month to20years, with median durationof18months. The synovial fluid group of15RA patients, the mean age was(44.53±14.17) yr, and12subjects were female,3subjects were male. Thecourse of the disease was from1month to15years, with median duration of36months. The group of20OA patients, the mean age was (51.90±12.13) yr,and12subjects were female,8subjects were male. The course of the diseasewas from4month to10years, with median duration of17months. In20 normal controls, with a mean age of (44.70±12.78) yr,12subjects were female,8subjects were male. There were no differences RA group, OA group andnormal group in between age and gender (P>0.05).2The serum levels of TL1A of RA patients: The serum levels of TL1A in RAgroup (1006.37±323.02pg/ml) were significant higher than OA group(593.61±239.22pg/ml, p<0.05) and normal controls (472.93±212.75pg/ml, p<0.05).And there was no statistical differences between OA group and normalcontrols (P>0.05). The serum levels of TL1A in RF+/RA group and RF+/RAgroup were (991.11±179.25) pg/ml and (1021.90±371.88)pg/mL, and therewere no statistical differences between the two groups (P>0.05).3The TL1A levels in synovial fluid were (848.13±372.65)pg/ml, which wereno statistical differences than serum (P>0.05). The TL1A levels in RF+/RAsynovial fluid group were1014.27±324.74)pg/ml, which were significantlyhigher than RF-/RA synovial fluid group(515.84±204.71)pg/ml (p<0.01).4The levels of IL-17in serum of RA group (77.54±23.60pg/ml) weresignificant lower than synovial fluid (154.10±16.89pg/ml)(P<0.01).5The levels of TNF-α in serum of RA group (45.08±19.18pg/ml) weresignificant lower than synovial fluid (153.20±16.59pg/ml)(P<0.01).6The correlation between TL1A and TNF-α, IL-17in RA group: According tocorrelation analysis, the level of TL1A in serum had positive correlation withthe levels of TNF-α and IL-17(r=0.449,0.373, P<0.05); the level of TL1A insynovial fluid had positive correlation with the levels of TNF-α andIL-17(r=0.560,0.542, P<0.05).7.The correlation between TL1A and clinical parameters in RA group:According to correlation analysis, the serum level of TL1A had significantpositive correlation with swollen joint count, tender joint count, DAS28andRF (r=0.616,0.681,0.527,0.668, P＜0.01); There was no correlation betweenthe level of TL1A in serum and ESR, CRP(P>0.05).The level of TL1A insynovial fluid had significant positive correlation with swollen joint count,tender joint count and RF (r=0.835,0.791,0.927, P＜0.01).There was nocorrelation between the level of TL1A in synovial fluid and ESR, CRP, DAS28(P>0.05).Conclusions:1The TL1A levels in serum and synovial fluid were significantly increased inRA patients. And the levels of TL1A were significantly correlated with RFand activity of disease. It suggested that TL1A play an important role in thepathogenesis and progression of RA.2The TL1A levels in RF+/RA synovial fluid were significantly higher thanRF-/RA synovial fluid, and the level of TL1A in synovial fluid and serum hadsignificant positive correlation with and RF. It suggested that the overactivatedof B lymphocyte might paly a role in the pathogenesis of RA.3The TL1A levels of OA were similar to normal controls. It suggested thatthe serum TL1A may be a way of identification of RA patients and OApatients.4There were higher level of IL-17and TNF-α in synovial fluid than in serum,which suggested that IL-17and TNF-α might have relation to pathologicalchanges of synovium of peripheral joint and articular cartilage destructions.5The level of TL1A in serum and synovial fluid had positive correlation withTNF-α and IL-17. It indirectly indicated that TL1A can enhance RA patientsTh17cells and Th1cell differentiation. |
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