| BackgroundRheumatoid Arthritis(RA)is a chronic inflammatory disease characterized by marked joint inflammation and swelling,joint tenderness,and synovial and bone destruction.Osteoarthritis(OA)is a chronic inflammatory joint disease involving the entire joint structure,including cartilage degradation,bone remodeling,osteophyte formation,and synovial inflammation,resulting in pain,stiffness,swelling,and loss of normal joint function.Gout is an inflammatory joint disease that occurs intermittently,and its chronic course can also lead to joint destruction.The etiology of these three inflammatory arthropathies is complex,and the pathogenesis is not fully understood.More and more studies have suggested that cytokines are important inflammatory mediators in the pathogenesis and progression of inflammatory diseases.The cytokines secreted by T helper cells(Th cells)include Th1 cytokines(Interleukin-2(IL-2),Interferon-γ(γ-IFN),and Tumor Necrosis Factor-α(TNF-α),Th2 cytokines(IL-4,IL-6 and IL-10).Recent studies have found that the development of RA is closely related to the imbalance of Th1/Th2 cells and their secreted cytokines.OA is mainly mediated by Th1 cells.The related research and detection of Th1/Th2 related cytokines TNF-α,γ-IFN,IL-2,IL-4,IL-6,and IL-10 in OA have also attracted much attention.The occurrence of gout is thought to be related to the activation of NLRP3(NOD-like receptor protein 3)inflammasome and the secretion of cytokine IL-1β.The remission of gout is related to anti-inflammatory factor IL-10.There are few studies on the role of other Th1/Th2 cytokines in the pathogenesis of Gout.ObjectiveThe aim of this study is to detect the levels of Th1/Th2 related cytokines(IL-2,IL-4,IL-6,IL-10,γ-IFN and TNF-α)in serum of patients with RA,OA and Gout,and to explore the expression of Th1/Th2 related cytokines in serum of patients with different inflammatory arthropathy.To investigate the expression of Th1/Th2 related cytokines in the synovial fluid of patients with RA,OA and Gout,and to explore the expression of Th1/Th2 related cytokines in synovial fluid of patients with different inflammatory arthropathy.To explore the potential value of Th1/Th2 related cytokines in reflecting the severity of RA and monitoring disease activity by studying the correlation between Th1/Th2 related cytokines in serum and synovial fluid and activity indicators(Erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),platelet count(PLT),DSA28)and inflammatory indicators(white blood cell count in joint fluid)in RA.MethodsThe serum samples from 45 patients with RA,24 patients with OA and 27 patients with Gout were collected from patients hospitalized in the Department of Rheumatology and Immunology,the Second Affiliated Hospital of Guangzhou Medical University from July 2021 to February 2023.Synovial fluid samples were collected from 22 patients with RA,30 patients with OA and 35 patients with Gout from patients who were to undergo joint puncture or minimally invasive needle-knife arthroscopic treatment.The levels of Th1/Th2 related cytokines(IL-2,IL-4,IL-6,IL-10,γ-IFN and TNF-α)were detected by flow cytometry.ESR,CRP,PLT and DSA28 were recorded in detail.ResultsComparison of Th1/Th2 cytokines in serum of three inflammatory arthropathies:The expression of IL-2,TNF-α,IL-6 in the serum of the three groups of inflammatory arthropathy were not all the same(P<0.05).There was no significant difference in the expression of γ-IFN,IL-4,IL-10 in the serum of the three groups of inflammatory arthropathy.The levels of IL-2,IL-6 and TNF-α in the RA were higher than those in the Gout(P<0.05).There was no significant difference in the expression levels of IL-2,IL-6 and TNF-α between RA and OA(P>0.05).The level of IL-2 in the OA was higher than that in the Gout(P=0.031),but there was no significant difference in the levels of IL-6 and TNF-α between the two groups.Correlation analysis of Th1/Th2 cytokines in serum of RA patients: the level of IL-6 in serum of RA patients was positively correlated with PLT,ESR,CRP and DSA28(P<0.05).The level of IL-10 in serum of RA patients was positively correlated with CRP(P<0.05),but not correlated with PLT,ESR and DSA28.The level of TNF-α in serum of RA patients was positively correlated with PLT and CRP(P<0.05),but not with ESR and DSA28.The expression levels of IL-2,IL-4 and γ-IFN in serum of RA patients were not correlated with PLT,ESR,CRP and DSA28.Comparison of Th1/Th2 cytokines in synovial fluid of three inflammatory arthropathies: The expression levels of IL-6,IL-10 and TNF-α in the synovial fluid of the three groups of inflammatory arthropathies were not all the same(P<0.05).The expression levels of IL-2,IL-4 and γ-IFN in the synovial fluid of the three groups of inflammatory arthropathies were not statistically different(P>0.05).Compared with Gout,the levels of IL-6,IL-10 and TNF-α in the synovial fluid of RA were higher(P<0.05).Compared with OA,the levels of IL-6 and IL-10 in the synovial fluid of RA were higher.(P<0.001).There was no significant difference in the expression level of TNF-α between the two groups(P=1.000).The IL-6 level in the synovial fluid of Gout group was significantly higher than OA(P<0.05),while the IL-10 and TNF-αlevels were not significantly different between Gout and OA.(P>0.05).Correlation analysis of Th1/Th2 cytokines in synovial fluid of RA patients: The level of IL-10 in RA patients was positively correlated with the leukocyte count in synovial fluid(rs=0.525,P=0.012),and the level of TNF-α in RA patients was positively correlated with the leukocyte count in synovial fluid(rs=0.479,P=0.024).There was no correlation between IL-2,IL-4,IL-6,γ-IFN and white blood cell count in synovial fluid.There was no correlation between Th1/Th2 cytokines and DSA28(P>0.05).Conclusions(1)There were significant differences in the expression of Th1 cytokines IL-2and TNF-α as well as Th2 cytokines IL-6 in serum among the three inflammatory arthritis diseases.The expression of IL-2,IL-6 and TNF-α in RA was higher than that in Gout,but there was no difference between RA and OA.The level of IL-2 in OA was higher than that in Gout,but there was no difference in the expression of IL-6 and TNF-α between OA and Gout.The inflammatory response in serum of RA patients was more active than gout patients.(2)The expression of TNF-α in Th1 cytokines and IL-10 and IL-6 in Th2 type cytokines in the synovial fluid of the three inflammatory arthritis diseases were different.The levels of IL-6,IL-10 and TNF-α in RA were higher than those in Gout,and the levels of IL-6 and IL-10 in RA were higher than those in OA.The level of IL-6 in the synovial fluid of Gout patients is higher than that of OA patients.The inflammatory response in the synovial fluid of RA is more active than that of Gout patients,as well as the inflammatory response in the synovial fluid of RA is more active than that of OA patients(3)The level of IL-6 in serum of patients with RA is positively correlated with ESR,CRP,PLT and DSA28.The expression level of IL-6 in serum may become a new index for the evaluation of RA disease activity.(4)The level of TNF-α and IL-10 in synovial fluid of patients with RA is positively correlated with the white blood cell count in synovial fluid.The level of TNF-α and IL-10 in synovial fluid may be used as an index to evaluate the degree of local inflammation of arthritis with RA. |
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