Coaccioli S, Di Cato L, Marioli D, Patucchi E, Pizzuti C, Ponteggia M, Puxeddu A
Rheumatology Unit, Dept. of Internal Medicine, Perugia University, Santa Maria Hospital, Via T. di Joannuccio 21, 05100 Terni, TR, Italy.
Panminerva Med. 2000 Dec;42(4):263-6.
Rheumatoid arthritis is characterized by an impaired immune response and a defective cutaneous cell-mediated immunity has been reported. This study was realised in order to determine the characteristics of cutaneous cell-mediated immunity in patients affected by recent-onset and untreated rheumatoid arthritis.
Forty-eight patients affected by newly diagnosed rheumatoid arthritis were studied by skin testing with seven common recall antigens. The skin tests were performed before the administration of disease modifying anti-rheumatic drugs (methotrexate, cyclosporine-A, hydroxychloroquine) and were repeated after four months of therapy.
43.75% of the RA patients (21 out of 48) were defined as anergic compared with 2% of the normal control subjects and the rate of depression of cutaneous cell-mediated immunity was not related either with the markers of disease activity or with the clinical assessment. The impaired cutaneous cell-mediated immunity shows a slight improvement after methotrexate therapy, while cyclosporine-A and hydroxychloroquine were not able to achieve the same result.
Rheumatoid arthritis shows a defective cutaneous cell-mediated immunity when the patients are studied in the early phase of the disease and before a second-line of therapy with disease modifying anti-rheumatic drugs. The anergy does not correlate either with the disease activity or with the short-term response to treatment. The prognostic significance of these data remains uncertain.
类风湿关节炎的特征是免疫反应受损，且已有报道称其存在皮肤细胞介导免疫缺陷。本研究旨在确定近期发病且未经治疗的类风湿关节炎患者皮肤细胞介导免疫的特征。
对48例新诊断类风湿关节炎患者进行7种常见回忆抗原的皮肤试验研究。皮肤试验在给予改善病情抗风湿药物（甲氨蝶呤、环孢素A、羟氯喹）之前进行，并在治疗4个月后重复进行。
43.75%的类风湿关节炎患者（48例中的21例）被定义为无反应性，而正常对照受试者中这一比例为2%，皮肤细胞介导免疫的抑制率与疾病活动标志物或临床评估均无关。甲氨蝶呤治疗后，受损的皮肤细胞介导免疫有轻微改善，而环孢素A和羟氯喹未能取得同样效果。
在类风湿关节炎疾病早期且在使用改善病情抗风湿药物进行二线治疗之前对患者进行研究时，发现其存在皮肤细胞介导免疫缺陷。无反应性与疾病活动或短期治疗反应均无关联。这些数据的预后意义仍不确定。
