Kanjana Korawit, Chevaisrakul Parawee, Matangkasombut Ponpan, Paisooksantivatana Karan, Lumjiaktase Putthapoom
Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Front Med (Lausanne). 2020 Feb 4;7:25. doi: 10.3389/fmed.2020.00025. eCollection 2020.
When the dose of conventional disease-modifying anti-rheumatic drugs (cDMARDs) is tapered in rheumatoid arthritis (RA) patients who achieve sustained remission, biomarkers for predicting disease relapse may be needed. A prospective, unblinded cohort study was conducted in nine RA patients with remission. Peripheral blood samples were collected at baseline and at 6, 12, and 24 weeks after cDMARD dose reduction (dose of combination regimens reduced to 50%) to determine the number of regulatory Foxp3T cells (Tregs) and other T cell subpopulations as well as Treg suppressive activity. Additionally, plasma levels of 14 cytokines at each time-point were measured via flow cytometry. Univariate and multivariate analyses were performed to identify the factor(s) associated with RA relapse during the observational period. In univariate analysis, Treg suppression and DAS28 and VAS scores were associated with RA relapse after cDMARD dose tapering. However, in multivariate analysis, only Treg suppressive activity (<42%) was found to be an independent factor associated with RA relapse after cDMARD dose reduction to 50%. Of all patients who had ≥42% Treg suppressive activity during cDMAD reduction, three-fourth patients remained in the remission stage for 24 weeks. Treg suppressive activity (<42%) in RA patients with remission could be a potential biomarker for predicting RA relapse after cDMARD dose reduction, especially over a short-term period (24 weeks).
在病情获得持续缓解的类风湿关节炎（RA）患者中，当传统抗风湿病情缓解药（cDMARDs）剂量逐渐减小时，可能需要用于预测疾病复发的生物标志物。对9例处于缓解期的RA患者进行了一项前瞻性、非盲队列研究。在基线以及cDMARD剂量降低（联合用药方案剂量降至50%）后的6周、12周和24周采集外周血样本，以确定调节性Foxp3T细胞（Tregs）及其他T细胞亚群的数量以及Treg抑制活性。此外，通过流式细胞术检测每个时间点14种细胞因子的血浆水平。进行单因素和多因素分析以确定观察期内与RA复发相关的因素。在单因素分析中，Treg抑制以及疾病活动评分28（DAS28）和视觉模拟评分（VAS）与cDMARD剂量逐渐减小后的RA复发相关。然而，在多因素分析中，仅发现Treg抑制活性（<42%）是cDMARD剂量降至50%后与RA复发相关的独立因素。在cDMAD剂量降低期间Treg抑制活性≥42%的所有患者中，四分之三的患者在24周内保持缓解状态。缓解期RA患者的Treg抑制活性（<42%）可能是预测cDMARD剂量降低后RA复发的潜在生物标志物，尤其是在短期内（24周）。
