| Objective: Rheumatoid arthritis (RA) is an autoimmune disease of unknown causes, which main clinical manifestation is chronic, symmetry, progressive polyarticular inflammation diseases. The patients of RA are distributed in the worldwide,including all racial and ethnic. Statistics from foreign shown that 0.5 to 1 percent of people has the disease of RA in the worldwide . According to incomplete statistics, 0.3 to 0.5 percent of people has RA in our country,and the ratio of male to female is about 1 to 3. On this basis, it approximately 4.5 million to 6 million patients in our country, which equivalent to a medium-sized cities'total population. In particular, 80 percent of the patients are young adults age of onset of 20 to 45 years, which result in varieties of family issues and a huge social burden. It can not be ignored that the damage of labor force and disability because of severe joint damage and dysfunction.Many studies have shown that RA is a kind of disease, which has closely related to the environment, cells, viruses, genetics, sex hormones and neuropsychiatric state. The main pathological feature is proliferation of synovial cells, infiltration of inflammatory cell, formation of pannus, damage of bone tissue and cartilage. The pannus formation is recognized as a major segment in the pathogenesis of RA, while angiogenesis is the main symbol of the pannus generation and maintenance in RA. A large number of cytokines play a central role in the regulation of angiogenesis with RA. In recent years, macrophage migration inhibitory factor (MIF) became a research hotspot because of it involved in pathogenesis of sepsis, cancer and autoimmune diseases. Vascular endothelial growth factor (VEGF) was known to be one of the strongest promote blood vessel growth factor which had a direct effect on the vascular endothelial cell mitogen,moreover VEGF play an important role in the formation of new blood vessels. Many studies shown that MIF and VEGF were highly expressed in tumor cells, and the expressions of MIF and VEGF were closely correlated with tumor germination, progression and distant metabasis. MIF may be induced the angiogenesis, invasion and metastasis in tumor via upregulation the expression of VEGF. But their roles have not been known in angiogenesis of RA. We measure the serum MIF and VEGF expression in RA patients by enzyme-linked immunosorbent assay (ELISA), analysis the relationship between the expression of serum MIF, VEGF and the clinical variables of RA, and explore the role of MIF and VEGF in the pathogenesis of RA.Methods: (1) Collected 56 cases of RA patients, which accorded with the American College of Rheumatology (ACR) 1987 revised criteria for the classification of RA. According to the criteria of diagnosis in RA activities stage and RA remission stage, they were divided into RA active group and RA remission group. 16 cases of osteoarthritis (OA) patients and 15 cases of healthy checkup were used as normal control group. The age, sex composition have no statistical difference in all groups. (2) Recorded the relevant information from all the members before the study: name, sex, age, disease duration, time of morning stiffness, erythrocyte sedimentation rate (ESR), platelet counting (PLT), C-reactive protein (CRP), Rheumatoid factor (RF), joint tenderness index, joint swelling index, joint activity pain index and joint resting pain index. (3) All study members need to draw 3 millilter blood from the vein of elbow in the morning and must be after empty stomach 8 hours, then extracted the liquid supernatant after centrifugation, holded in -70℃low temperature refrigerator, dissolved all the apecimen before the experiment at the common room temperature. (4) The serum level of MIF and VEGF were measured by enzyme-linked immunosorbent assay (ELISA), the steps and methods were strictly accordence with the requirements of kit instructions, read the absorbance (A) values, draw the standard curve which abscissa was the concentration of standard products and the vertical axis was the OD value, then calculated the serum concentrations of MIF and VEGF in all groups. (5) Application SPSS13.0 statistical software for statistical analysis.Results: (1) The serum level of MIF and VEGF were significantly higher in the RA group than in the OA group (P<0.05) and in the healthy control (P<0.01). (2) The serum level of MIF and VEGF were significantly higher in active group of RA than those in remission group (P<0.01). (3)There were significant correlation between the serum level of MIF,VEGF and the clinical variables of RA disease activity, included ESR,PLT,CRP,joint tenderness index, joint swelling index, joint activity pain index and joint resting pain index (P<0.01). But there were no correlation between the serum level of MIF, VEGF and age, disease duration and RF (P>0.05). (4) The serum level of MIF had good correlation with the serum level of VEGF in active group of RA (P<0.01), while the serum level of MIF and VEGF were no correlation in the remission group of RA,OA group and normal control group (P>0.05).Conclusions: (1) MIF and VEGF were high level presence in the serum of patients with RA. It was shown that they were involved in the pathogenesis of RA. (2) It contributed to judgment the activity of RA by detecting the serum MIF and VEGF. (3) There was a positive correlation between the serum level of MIF and VEGF in active group of RA. It was shown that MIF may be take part in the generation of VEGF.
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