Clinical Significance Of Inflammatory Cytokines In Systemic Juvenile Idiopathic Arthritis

ObjectiveDetecting the cytokines expression levels in the sJIA patients’ peripheral bloods,including IL-1β,IL-6,IL-10 and IL-17 A,to analyze the correlations of cytokines with disease activity and the IL-6 receptor antagonist,as well to discuss their role and clinical significances in sJIA.MethodTo collect 90 children with sJIA,who were diagnosed and classified of the 2001 ILAR JIA standard in the Rheumatology and Immunology Department of Xi’an Children’s hospital during August 2016 to March 2018.To sort out the clinical features and clinical test results of the cases.Divided all cases into different activity groups according to DAS28 score.Of these,18 patients for the first time used of Tocilizumab for the first time.Finally,13 patients were followed regularly.We collected the peripheral blood which were taken at different stages of the sJIA patients,and detected the cytokines by flow cytometry.Results1、The clinical features of sJIA: The average age of sJIA in 90 cases was 6.04 years old,(ranged 3.90 months-14.00 years old),male: female=1.14:1,the average course of disease was 0.12 years,and the duration of disease was 0.47 months-6 years.The main symptoms of sJIA included fever in 90 cases(100%),rash in 63 cases(70%),arthritis in 60 cases(66.67%),triad in 33 cases(36.67%),and macrophage activation syndrome in 6 cases(6.67%).Forlaboratory examination,the count of white blood cells,erythrocyte sedimentation rate,C-reactive protein and serum ferritin were significantly elevated,66 cases(75%)were bone marrow infections.2、The cytokines expression level with sJIA disease activity: We have found the level of IL-1β and DAS28 scores were correlated(P<0.05),the level of IL-6 and IL-17 A were positively correlation with DAS28(P<0.05),IL-10 was negatively correlated with DAS28(P<0.05).With disease activity decreased,levels of IL-1β,IL-6 and IL-17 A decreased(P<0.05),but IL-10 increased(P<0.05).3、The treatment effect of IL-6 receptor antagonist and the effect on cytokine: DAS28 score after tocilizumab treatment decreased significantly(P<0.05),patients with good reaction(n=12,66.67%)and moderate response(n=5,27.78%)accounted for the majority,IL-1β,IL-6and IL-17 A levels were decreased(P<0.05)after the treatment,IL-10 increased after treatment(P < 0.05),IL-1,IL-6 and IL-17 A in follow-up groups stay low levels.Conlusion:1、The clinical manifestations of sJIA are diverse,the diagnosis is relatively difficult,the inflammatory indexes including ESR,CRP and SF are significantly elevated,in line with the characteristics of autoimmune diseases.2、The cytokines levels of sJIA patients are different in active stage and remission.Level of Th1 and Th17 related cytokines(IL-1β,IL-6 and IL-17A)are positively correlation with disease activity indexes DAS28,Level of Th2 and Treg related cytokines(IL-10)is negativelycorrelation with DAS28.3 、DAS28 scores of the sJIA patients who used IL-6 receptor antagonis came down significantly,the rate of clinical syndromes remission rose.There were changes in cytokines expressions after tocilizumab treatment(IL-1β,IL-6 and IL-17 A down-regulation,IL-10up-regulation).The children with the normative treatment of tocilizumab can have sustained disease remission and reduce adverse reactions,too.