Year: 2023
Type: conference-abstract
Abstract: Background Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis driven by an inflammatory cascade of different cytokine families. IL-23/Th17 axis cytokine (IL-23, IL-17) has been studied as a key pathway for disease development and its association with disease severity, joint erosion and functional outcome [1], but the data supplementing to support the hypothesis is lacking and conflicting. Also, there is a paucity of data on the role of IL-23/Th17/IL-17 axis cytokines in an Indian subset of patients. Objectives The objective was to find the correlation between serum cytokines (IL-17, IL-23) and clinical parameters of Rheumatoid arthritis patients, e.g., disease activity (DAS28) and functional status. Methods This cross-sectional observational study was conducted in General Medicine OPD from 2021 to 2022. ACR/EULAR 2010 classification criteria was used to diagnose RA. Eighty-four consecutive RA patients were recruited after taking consent. Serum IL-17 and IL-23 levels were measured by the ELISA method. Clinical and laboratory parameters, DAS28-ESR, and HAQII were recorded. Data were analyzed to find the correlation between cytokine and disease parameters, and compare cytokine levels in different subgroups. Results The study showed a higher proportion of females than males (n=76,90.5% vs n=8,9.5%). 14.28%(n=12) cases were elderly RA. 90.5% were taking cDMARDs, whereas 48.8% (n=41) were steroid users. Majority of cases, 57.14% (n=48) had high disease activity, whereas 25% (n=21) had moderate disease activity. Cases achieved remission was 5.95%. The median value of serum IL-17 and IL-23 were 103.72 pg/ml (IQR=39.91-524.13) and 981.87 pg/ml (IQR=793.25-1205.0), respectively. Swollen joint count, but not tender joint count, correlated positively with both IL-17 and IL-23 levels (rs=0.229, p=0.036; rs=0.098, p=0.016, respectively). Among the inflammatory marker, only CRP correlated positively with IL-23 (rs=0.269, p=0.014). Both IL-17 and IL-23 levels showed an insignificant, weak positive correlation with the disease activity DAS28 (rs=0.183, p=0.097 & rs=0.125, p=0.259), respectively. There was no difference in IL-17 and IL-23 levels among the disease severity group (p=0.130 & p=0.215). It was also noted that IL-17 was positively correlated with IL-23 (rs=0.221, p=0.044). Among the cytokines, only IL-23 had shown a statistically positive correlation with functional status (HAQII) (rs=0.284, p=0.009). IL-23 level differed significantly between males and females (p=0.013). Also, advanced RA had higher IL-17 level than early RA (p=0.028). Neither IL-17 nor IL-23 level showed any difference between the subgroup e.g., age (younger RA vs elderly RA), obesity (obese vs nonobese), DMARDs or steroid (user vs naïve), serology status (RF+ vs RF- & CCP+ vs CCP-). Conclusion Serum IL-17 levels were high in advanced RA as compared to early RA. Both IL-17 and IL-23 correlated positively with the swollen joint count. Only IL-23 was directly correlating with CRP and functional status. Both IL-17 and IL-23 had a weak, insignificant positive correlation with disease activity, and there was no difference in cytokines level among severity classes. Even cDMARD/steroid use did not affect the cytokines level. IL-17 receptor activation triggers transformations of acute synovitis to chronic persistent arthritis [2]. IL-23/IL-17 may be a factor for advanced/erosive disease develoment, which need further research. Hence, blocking IL-23 and IL-17 at an early stage may diminish IL-17 activity, retard the progression to chronic inflammatory arthritis and advanced disease. References [1]Lubberts E. The IL-23-IL-17 axis in inflammatory arthritis. Nat Rev Rheumatol. 2015 Jul;11(7):415-29. [2]Lubberts E, Schwarzenberger P, Huang W, Schurr JR, Peschon JJ, van den Berg WB, Kolls JK. Requirement of IL-17 receptor signaling in radiation-resistant cells in the joint for full progression of destructive synovitis. J Immunol. 2005 Sep 1;175(5):3360-8. Acknowledgements We thank Dr.Amit Mishra for helping in data analysis. Disclosure of Interests None Declared.
Source: Annals of the Rheumatic Diseases
Institution: All India Institute of Medical Sciences Raipur
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4379649173