The Role Of Serum TNF-α And IL-6 In Rheumatoid Arthritis In The Real World

Research BackgroundRheumatoid arthritis(RA)is a chronic systemic disease and one of the most disabling diseases in clinical.In China,the disease incidence is 0.19%-0.41%,and females are four times more likely to develop RA than are males.Recent research has shown that rapid progression of disease could occur during the early stage of RA and thus the strategy of early diagnosis,early treatment and treat-to-target for RA patients was adopted in clinical,to expecte to stop the progress of the disease as soon as possible.Current studies have shown that the serum levels of TNF-a and IL-6 in patients with RA may increase.Biologicals related to TNF-α and IL-6 have been widely used in RA patients.Whether serum levels of TNF-α and IL-6 are useful in evaluating disease activity and prognosis of patients with RA,and whether they can guide the treatment of RA,are still questionable.ObjectiveTo study whether the serum levels of TNF-α and IL-6 in patients with RA can evaluate the disease activity;In the meanwhile,explore their potential value in assessing efficacy and guiding treatment,as well as their relationship with other test indicators.Subjects and MethodsFrom February,2017 to September,2018,patients with RA who were treated in outpatient or in-patient clinics in Southern Medical University Nanfang Hospital were selected as the subjects of this study.Patients should meet the 2010 American Rheumatism Society/European Anti-Rheumatism Alliance(ACR/EULAR)RA classification criteria or 1987 ACR on RA classification criteria.All the enrolling patients’medical history/demographic data,blood routine,liver function,renal function,autoantibodies,TNF-α,IL-6,humoral immunity parameters and therapeutic drugs were collected.By comparing the demographic data of patients with different course of disease groups,the comparability of the subjects was evaluated.According to the 2015 ACR classification criteria,RA patients were divided into early RA patients and long-term RA patients by course of disease,and then serum levels of TNF-α and IL-6 and their relationship with DAS28 were compared between the two groups.The serum levels of TNF-α and IL-6 in RA patients were correlated analysis with DAS28.The serum levels of TNF-α and IL-6 were correlated analysis with those of blood routine,autoantibody and humoral immunity parameters in patients with RA.The serum levels of TNF-α and IL-6 were compared between reaching treatment target group and no reaching treatment target group.After different drug treatments,the correlation between serum levels of TNF-α and IL-6 and DAS28 was compared.The SPSS 20.0 statistical software were used for analyzing datum.The measurement data were assessed by t-test or nonparametric tests and the chi-square test was used for enumeration data.With test level a=0.05,when P<0.05,the difference was statistically significant.Multivariate logistic regression analysis was used to explore whether serum TNF-α,IL-6 and so on were risk factors for reaching treatment target in RA.Results1.Serum TNF-α had no significant relationship with DAS28-ESR,DAS28-CRP,SDAI and CDAI in RA patients.Serum TNF-α was not supported for the purpose of assessing RA disease activity.2.There was a low positive correlation between serum IL-6 and DAS28-ESR,SDAI and CDAI in RA patients.Serum IL-6 had a moderate positive correlation with DAS28-CRP.In addition,serum IL-6 in no reaching treatment target group was higher than it in reaching treatment target group,so serum IL-6 could be used to evaluate disease activity.3.Serum TNF-α had a positive correlation with CRP and RF in RA patients,but the degree of correlation was low.Serum IL-6 had a moderate positive correlation with ESR and CRP,a low positive correlation with WBC,PLT,RF,C3,IgA and IgG，a low negative correlation with Hb.4.In the treatment of RA,there was no significant correlation between serum TNF-α and DAS28-ESR,DAS28-CRP,SDAI and CDAI,when treated with DMARDs regimen.After treatment with TNF-α receptor antagonists,serum TNF-αhad no significant correlation with DAS28-ESR and DAS28-CRP.When DMARDs regimens were used to treat RA,serum IL-6 was low positively correlated with DAS28-ESR,DAS28-CRP,SDAI and CDAI,which indicated that serum IL-6 could be used to judge the disease activity of RA patients treated under these treatment schemes.After treatment with TNF-α receptor antagonist,serum IL-6 was moderately positively correlated with DAS28-CRP,and low correlated with DAS28-ESR but without statistical significance,indicating that serum IL-6 couldn’t be used to judge the disease activity of RA patients treated under this treatment regimen.5.Binary Logistic multivariate analysis indicated that ESR and CRP were risk factors for RA failure,while serum TNF-α and IL-6 were not risk factors for RA failure.Conclusions1.Serum IL-6 can be used to evaluate disease activity of RA patients,but further research is needed to determine whether serum TNF-α can be used to assess disease activity in RA patients.2.In RA patients,serum IL-6 is positively correlated with CRP,ESR,WBC,PLT,RF,C3,IgA and IgG,negatively correlated with Hb.Serum TNF-α is positively correlated with RF and CRP.3.When DMARDs regimens are used to treat RA,serum IL-6 can be used to help judge the disease activity and treatment effect of RA patients under these treatment regimens.4.ESR and CRP are risk factors for RA patients who do not reach the treatment target,but serum TNF-α and IL-6 are not.