Sliwinska-Stanczyk P, Pazdur J, Ziolkowska M, Jaworski J, Kaminska-Tchorzewska E, Lacki J K
Department of Rheumatic Diseases, Institute of Rheumatology, Warsaw, Poland.
Scand J Rheumatol. 2007 May-Jun;36(3):167-71. doi: 10.1080/03009740601154111.
Glucocorticoids (GCs) are among the most frequently used drugs for the treatment of rheumatoid arthritis (RA). Unfortunately, up to 30% of patients with RA fail to respond to the treatment. We investigated the hypothesis that patients with RA who did not respond to GC treatment have steroid-resistant peripheral blood mononuclear cells (PBMCs).
Forty-four patients with RA were enrolled in the study. PBMCs were isolated from blood samples. The effect of methylprednisolone (MP) on the proliferation of stimulated cells was measured. After taking the blood samples, 10 days of MP therapy (20 mg i.v.) was started, in order to classify the patients into either a GC-sensitive (RA/GCS) or a GC-resistant (RA/GCR) group.
A quarter of our patients did not show any improvement after short-term GC therapy and were assigned to the RA/GCR group. The inhibition of PBMC proliferation after MP treatment was significantly lower in the RA/GCR as compared to the RA/GCS group.
Based on the close relationship between clinically observed GC resistance and a diminished response of PBMCs to MP treatment, we conclude that measurement of the steroid sensitivity of PBMCs may be a useful tool in predicting the therapeutic effect of GC in patients with RA.
糖皮质激素（GCs）是治疗类风湿关节炎（RA）最常用的药物之一。不幸的是，高达30%的RA患者对该治疗无反应。我们研究了一个假设，即对GC治疗无反应的RA患者具有类固醇抵抗性外周血单核细胞（PBMCs）。
44例RA患者纳入本研究。从血样中分离PBMCs。测定甲泼尼龙（MP）对刺激细胞增殖的影响。采集血样后，开始为期10天的MP治疗（静脉注射20mg），以便将患者分为GC敏感（RA/GCS）组或GC抵抗（RA/GCR）组。
我们的患者中有四分之一在短期GC治疗后未显示任何改善，被归入RA/GCR组。与RA/GCS组相比，RA/GCR组中MP治疗后PBMC增殖的抑制作用明显更低。
基于临床观察到的GC抵抗与PBMCs对MP治疗反应减弱之间的密切关系，我们得出结论，PBMCs类固醇敏感性的测定可能是预测GC对RA患者治疗效果的有用工具。
