1
|
Bekaryssova D, Mruthyunjaya Vijaya P, Ahmed S, Sondur S, Zimba O. Revisiting articular syndrome in the peri-pandemic COVID-19 era. Rheumatol Int 2023; 43:2157-2166. [PMID: 37747562 DOI: 10.1007/s00296-023-05459-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 09/26/2023]
Abstract
Articular syndrome is often the presentation of a person's various rheumatic or related diseases. It includes both arthralgia and arthritis, with objective signs of joint inflammation defining the latter. This syndromic approach to joint pain enables a scientific method for early diagnosis of common rheumatic conditions without compromising the recognition of uncommon conditions. This review explores common rheumatic conditions associated with articular syndrome, including osteoarthritis, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE). It supports the early differentiation of uncommon but emerging entities such as reactive arthritis (ReA). The aim of the review is to comprehensively overview various forms of articular syndrome to update rheumatologists' and allied health specialists' knowledge. Epidemiology, clinical presentations, diagnostic approaches, and therapeutic strategies are discussed in the context of articular syndrome. The challenges emerging in the peri-pandemic COVID-19 era are highlighted. The improved understanding of the spectrum of clinical conditions and disease states presenting with articular syndrome may facilitate early diagnosis, optimal management, and enhanced patient outcomes within the realm of rheumatology.
Collapse
Affiliation(s)
- Dana Bekaryssova
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan.
| | - Prakashini Mruthyunjaya Vijaya
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Suhas Sondur
- Department of Orthopedics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Kraków, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| |
Collapse
|
2
|
Mol S, Taanman-Kueter EWM, van der Steen BA, Groot Kormelink T, van de Sande MGH, Tas SW, Wauben MHM, de Jong EC. Hyaluronic Acid in Synovial Fluid Prevents Neutrophil Activation in Spondyloarthritis. Int J Mol Sci 2023; 24:ijms24043066. [PMID: 36834478 PMCID: PMC9964069 DOI: 10.3390/ijms24043066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
Spondyloarthritis (SpA) patients suffer from joint inflammation resulting in tissue damage, characterized by the presence of numerous neutrophils in the synovium and synovial fluid (SF). As it is yet unclear to what extent neutrophils contribute to the pathogenesis of SpA, we set out to study SF neutrophils in more detail. We analyzed the functionality of SF neutrophils of 20 SpA patients and 7 disease controls, determining ROS production and degranulation in response to various stimuli. In addition, the effect of SF on neutrophil function was determined. Surprisingly, our data show that SF neutrophils in SpA patients have an inactive phenotype, despite the presence of many neutrophil-activating stimuli such as GM-CSF and TNF in SF. This was not due to exhaustion as SF neutrophils readily responded to stimulation. Therefore, this finding suggests that one or more inhibitors of neutrophil activation may be present in SF. Indeed, when blood neutrophils from healthy donors were activated in the presence of increasing concentrations of SF from SpA patients, degranulation and ROS production were dose-dependently inhibited. This effect was independent of diagnosis, gender, age, and medication in the patients from which the SF was isolated. Treatment of SF with the enzyme hyaluronidase strongly reduced the inhibitory effect of SF on neutrophil activation, indicating that hyaluronic acid that is present in SF may be an important factor in preventing SF neutrophil activation. This finding provides novel insights into the role of soluble factors in SF regulating neutrophil function and may lead to the development of novel therapeutics targeting neutrophil activation via hyaluronic acid or associated pathways.
Collapse
Affiliation(s)
- Sanne Mol
- Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands
| | - Esther W. M. Taanman-Kueter
- Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Baltus A. van der Steen
- Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Tom Groot Kormelink
- Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Marleen G. H. van de Sande
- Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Sander W. Tas
- Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Marca H. M. Wauben
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands
| | - Esther C. de Jong
- Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-20-5664963
| |
Collapse
|
3
|
Pal A, Roongta R, Mondal S, Sinha D, Sinhamahapatra P, Ghosh A, Chattopadhyay A. Does post-COVID reactive arthritis exist? Experience of a tertiary care centre with a review of the literature. REUMATOLOGIA CLINICA 2023; 19:67-73. [PMID: 35578636 PMCID: PMC9096625 DOI: 10.1016/j.reuma.2022.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/06/2022] [Indexed: 02/07/2023]
Abstract
Background Rheumatological manifestations following COVID-19 are various, including Reactive Arthritis (ReA), which is a form of asymmetric oligoarthritis mainly involving the lower limbs, with or without extra-articular features. The current case series describes the clinical profile and treatment outcome of 23 patients with post-COVID-19 ReA. Methods A retrospective, observational study of patients with post-COVID-19 arthritis over one year was conducted at a tertiary care centre in India. Patients (n = 23) with either a positive polymerase chain reaction test for SARS-CoV2 or an anti-COVID-19 antibody test were included. Available demographic details, musculoskeletal symptoms, inflammatory markers, and treatment given were documented. Results Sixteen out of 23 patients were female. The mean age of the patients was 42.8 years. Nineteen patients had had symptomatic COVID-19 infection in the past. The duration between onset of COVID-19 symptoms and arthritis ranged from 5 to 52 days with a mean of 25.9 days. The knee was the most involved joint (16 out of 23 cases). Seven patients had inflammatory lower back pain and nine had enthesitis. Most patients were treated with non-steroidal anti-inflammatory drugs (NSAIDs) and steroids - either depot injection or a short oral course. Three patients required treatment with hydroxychloroquine and methotrexate which were eventually stopped. No relapse was reported in any of the patients. Conclusion On combining our data with 21 other case reports of ReA, a lower limb predominant, oligoarticular, asymmetric pattern of arthritis was seen with a female preponderance. The mean number of joints involved was 2.8. Axial symptoms and enthesitis were often coexistent. Treatment with NSAIDs and intra-articular steroids was effective. However, whether COVID-19 was the definitive aetiology of the arthritis is yet to be proven.
Collapse
Affiliation(s)
- Atanu Pal
- Department of Nephrology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Rashmi Roongta
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Sumantro Mondal
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Debanjali Sinha
- Department of Clinical Immunology and Rheumatology, Institute of Neurosciences, Kolkata, India
| | - Pradyot Sinhamahapatra
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Alakendu Ghosh
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Arghya Chattopadhyay
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India,Corresponding author
| |
Collapse
|
4
|
Does post-COVID reactive arthritis exist? Experience of a tertiary care centre with a review of the literature. REUMATOLOGIA CLINICA 2023; 19:67-73. [PMID: 36739121 PMCID: PMC9892928 DOI: 10.1016/j.reumae.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/06/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Rheumatological manifestations following COVID-19 are various, including Reactive Arthritis (ReA), which is a form of asymmetric oligoarthritis mainly involving the lower limbs, with or without extra-articular features. The current case series describes the clinical profile and treatment outcome of 23 patients with post-COVID-19 ReA. METHODS A retrospective, observational study of patients with post-COVID-19 arthritis over one year was conducted at a tertiary care centre in India. Patients (n=23) with either a positive polymerase chain reaction test for SARS-CoV2 or an anti-COVID-19 antibody test were included. Available demographic details, musculoskeletal symptoms, inflammatory markers, and treatment given were documented. RESULTS Sixteen out of 23 patients were female. The mean age of the patients was 42.8 years. Nineteen patients had had symptomatic COVID-19 infection in the past. The duration between onset of COVID-19 symptoms and arthritis ranged from 5 to 52 days with a mean of 25.9 days. The knee was the most involved joint (16 out of 23 cases). Seven patients had inflammatory lower back pain and nine had enthesitis. Most patients were treated with non-steroidal anti-inflammatory drugs (NSAIDs) and steroids - either depot injection or a short oral course. Three patients required treatment with hydroxychloroquine and methotrexate which were eventually stopped. No relapse was reported in any of the patients. CONCLUSION On combining our data with 21 other case reports of ReA, a lower limb predominant, oligoarticular, asymmetric pattern of arthritis was seen with a female preponderance. The mean number of joints involved was 2.8. Axial symptoms and enthesitis were often coexistent. Treatment with NSAIDs and intra-articular steroids was effective. However, whether COVID-19 was the definitive aetiology of the arthritis is yet to be proven.
Collapse
|
5
|
Maikap D, Padhan P. Successful use of tofacitinib in reactive arthritis refractory to conventional therapies - a case series. Mod Rheumatol Case Rep 2022; 6:167-170. [PMID: 35024869 DOI: 10.1093/mrcr/rxab029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/20/2021] [Accepted: 08/18/2021] [Indexed: 06/14/2023]
Abstract
Reactive arthritis is an immune-mediated aseptic arthritis resulting from either genitourinary or gastrointestinal tract in a genetically susceptible host. It commonly presents as oligoarthritis of the lower limbs with or without extra-articular features such as urethritis and non-purulent conjunctivitis. Therapies include non steroidal anti inflammatory drugs (NSAIDs), conventional disease modifying anti-rheumatic drugs (DMARDs) and, rarely, biologics in severe cases. We report the successful use of tofacitinib in four cases of reactive arthritis who failed to respond to conventional therapies.
Collapse
Affiliation(s)
- Debashis Maikap
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha 751024, India
| | - Prasanta Padhan
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha 751024, India
| |
Collapse
|
6
|
Liao HT, Tsai CY, Lai CC, Hsieh SC, Sun YS, Li KJ, Shen CY, Wu CH, Lu CH, Kuo YM, Li TH, Chou CT, Yu CL. The Potential Role of Genetics, Environmental Factors, and Gut Dysbiosis in the Aberrant Non-Coding RNA Expression to Mediate Inflammation and Osteoclastogenic/Osteogenic Differentiation in Ankylosing Spondylitis. Front Cell Dev Biol 2022; 9:748063. [PMID: 35127698 PMCID: PMC8811359 DOI: 10.3389/fcell.2021.748063] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/09/2021] [Indexed: 12/17/2022] Open
Abstract
Ankylosing spondylitis (AS) or radiographic axial spondyloarthritis is a chronic immune-mediated rheumatic disorder characterized by the inflammation in the axial skeleton, peripheral joints, and soft tissues (enthesis, fascia, and ligament). In addition, the extra-skeletal complications including anterior uveitis, interstitial lung diseases and aortitis are found. The pathogenesis of AS implicates an intricate interaction among HLA (HLA-B27) and non-HLA loci [endoplasmic reticulum aminopeptidase 1 (ERAP1), and interleukin-23 receptor (IL23R), gut dysbiosis, immune plasticity, and numerous environmental factors (infections, heavy metals, stress, cigarette smoking, etc.) The latter multiple non-genetic factors may exert a powerful stress on epigenetic regulations. These epigenetic regulations of gene expression contain DNA methylation/demethylation, histone modifications and aberrant non-coding RNAs (ncRNAs) expression, leading to inflammation and immune dysfunctions. In the present review, we shall discuss these contributory factors that are involved in AS pathogenesis, especially the aberrant ncRNA expression and its effects on the proinflammatory cytokine productions (TNF-α, IL-17 and IL-23), T cell skewing to Th1/Th17, and osteoclastogenic/osteogenic differentiation. Finally, some potential investigatory approaches are raised for solving the puzzles in AS pathogenesis.
Collapse
Affiliation(s)
- Hsien-Tzung Liao
- Division of Allergy, Immunology and Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Chang-Youh Tsai
- Division of Allergy, Immunology and Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- *Correspondence: Chang-Youh Tsai, ; Chia-Li Yu,
| | - Chien-Chih Lai
- Division of Allergy, Immunology and Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Song-Chou Hsieh
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Syuan Sun
- Division of Allergy, Immunology and Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Ko-Jen Li
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chieh-Yu Shen
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Han Wu
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Hsun Lu
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Min Kuo
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzu-Hao Li
- Division of Allergy, Immunology and Rheumatology, Taipei, Taiwan
- Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chung-Tei Chou
- Division of Allergy, Immunology and Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Chia-Li Yu
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- *Correspondence: Chang-Youh Tsai, ; Chia-Li Yu,
| |
Collapse
|
7
|
Parida JR, Kumar S, Ahmed S, Chaurasia S, Mukherjee R, Singh R, Ravindran B, Aggarwal A, Misra R. Reactive arthritis and undifferentiated peripheral spondyloarthritis share human leucocyte antigen B27 subtypes and serum and synovial fluid cytokine profiles. Rheumatology (Oxford) 2021; 60:3004-3011. [PMID: 34144605 DOI: 10.1093/rheumatology/keaa746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/07/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Peripheral SpA (pSpA) is comprised of ReA, PsA, enteritis-associated arthritis and undifferentiated pSpA (upSpA). ReA and upSpA share T cell oligotypes and metabolomics in serum and SF. We investigated HLA-B27 subtypes and cytokines in serum and SF that were compared between ReA and upSpA. METHODS ReA and upSpA were compared in two cohorts. In cohort I (44 ReA and 56 upSpA), HLA-B27 subtyping was carried out. In cohort II (17 ReA and 21 upSpA), serum and SF cytokines were compared using a multiplex cytokine bead assay (27 cytokines). A total of 28 healthy controls with similar age and sex to cohort II were included for comparison of serum cytokine levels. RESULTS In cohort I, HLA-B27 was positive in 81.8% (36/44) of ReA and 85.71% (48/56) of upSpA patients. HLA-B27 typing was successful in 70 patients (30 ReA and 40 uSpA). HLA-B*2705 was the most common, followed by HLA-B*2704 and HLA-B*2707. Frequencies were the same between ReA and upSpA. In cohort II, 14 cytokines were detectable in the serum of patients. The levels of eight cytokines were higher than in the controls. The cytokine levels of ReA and upSpA were similar. Sixteen cytokines were detectable in the SF of patients. There was no statistical difference in the levels between ReA and upSpA. The cytokine profiles in sera and SF were also similar among HLA-B27-positive and negative patients. CONCLUSION ReA and upSpA have similar HLA-B27 subtype associations and similar cytokine profiles. They should be considered as a single entity during studies as well as clinical management.
Collapse
Affiliation(s)
- Jyoti Ranjan Parida
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.,Department of Clinical Immunology & Rheumatology IMS and SUM Hospital and Medical College, Bhubaneswar, India
| | - Sandeep Kumar
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.,Department of Medicine, Section Pulmonary Disease, Tulane University, New Orleans, LA, USA
| | - Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.,Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Smriti Chaurasia
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.,Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ratnadeep Mukherjee
- Infectious Disease Biology Group, Institute of Life Sciences, Bhubaneswar, India.,Immunodynamics Section, Laboratory of Integrative Cancer Immunology, Centre for Cancer Research -National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rajeev Singh
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.,ICMR-Regional Medical Research Centre, Ministry of Health and Family Welfare, Government of India, BRD Medical College Campus, Gorakhpur, India
| | - Balachandran Ravindran
- Institute of Life Sciences, Bhubaneswar, India.,Institute of Life Sciences, Bhubaneswar, India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ramnath Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.,Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| |
Collapse
|
8
|
Tang X, Jing T, Chen X, Wang T, Xie Y, Chen F, Wen Y, Chang J, Chen D, Ma W. Interleukin-17 mediates inflammatory tissue injury during orf development in goats. Vet Microbiol 2021; 258:109105. [PMID: 33991787 DOI: 10.1016/j.vetmic.2021.109105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/06/2021] [Indexed: 01/13/2023]
Abstract
Orf is an epithelial zoonotic infectious disease caused by orf virus (ORFV). Mounting studies have shown that IL-17-driven neutrophil inflammation plays a central role in inflammatory skin diseases. However, whether IL-17 plays a similar role and how does it work in the pathogenesis of orf is unclear. In this study, we found that during orf development, numerous inflammatory cells, especially neutrophils, infiltrated in the damaged lip tissue. Meanwhile, the production of IL-17 was increased in the lesion site. Further evidence showed that IL-17 potently stimulated the production of several chemokines that are crucial for neutrophil migration. In addition, IL-17 was mostly produced by CD4+ T cells and gamma delta T (γδ T) cells of the skin. In conclusion, the present study highlighted a critical role of IL-17-driven inflammation in the pathogenesis of orf and suggested that this cytokine may be a potential therapeutic target of this disease in goats.
Collapse
Affiliation(s)
- Xidian Tang
- Veterinary Immunology Laboratory, College of Veterinary Medicine, Northwest Agriculture and Forestry University, Yangling 712100, Shaanxi Province, China
| | - Tian Jing
- Veterinary Immunology Laboratory, College of Veterinary Medicine, Northwest Agriculture and Forestry University, Yangling 712100, Shaanxi Province, China
| | - Xi Chen
- Veterinary Immunology Laboratory, College of Veterinary Medicine, Northwest Agriculture and Forestry University, Yangling 712100, Shaanxi Province, China
| | - Tianxing Wang
- Veterinary Immunology Laboratory, College of Veterinary Medicine, Northwest Agriculture and Forestry University, Yangling 712100, Shaanxi Province, China
| | - Yanfei Xie
- Veterinary Immunology Laboratory, College of Veterinary Medicine, Northwest Agriculture and Forestry University, Yangling 712100, Shaanxi Province, China
| | - Fengqiang Chen
- Veterinary Immunology Laboratory, College of Veterinary Medicine, Northwest Agriculture and Forestry University, Yangling 712100, Shaanxi Province, China
| | - Ying Wen
- State Key Laboratory of Plateau Ecology and Agriculture, Qinghai University, Xining 810016, Qinghai Province, China; College of Agriculture and Animal Husbandry, Qinghai University, Xining 810016, Qinghai Province, China
| | - Jianjun Chang
- State Key Laboratory of Plateau Ecology and Agriculture, Qinghai University, Xining 810016, Qinghai Province, China; College of Agriculture and Animal Husbandry, Qinghai University, Xining 810016, Qinghai Province, China
| | - Dekun Chen
- Veterinary Immunology Laboratory, College of Veterinary Medicine, Northwest Agriculture and Forestry University, Yangling 712100, Shaanxi Province, China.
| | - Wentao Ma
- Veterinary Immunology Laboratory, College of Veterinary Medicine, Northwest Agriculture and Forestry University, Yangling 712100, Shaanxi Province, China.
| |
Collapse
|
9
|
Treatment of reactive arthritis with biological agents: a review. Biosci Rep 2021; 40:222065. [PMID: 32039436 PMCID: PMC7033307 DOI: 10.1042/bsr20191927] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 02/02/2020] [Accepted: 02/05/2020] [Indexed: 12/31/2022] Open
Abstract
The pathogenesis of reactive arthritis (ReA) has not been fully elucidated. In recent years, many researchers have confirmed that multiple cytokines are involved in the occurrence and development of ReA. Although ReA is self-limiting, it is still incurable for some patients who have no or a weak response to traditional drugs, such as non-steroidal anti-inflammatory agents, glucocorticoids and immunosuppressive agents. This is called refractory reactive arthritis. Currently, there is insufficient evidences for the treatment of refractory ReA with biological agents, though biological agents against cytokines have been developed over the past few years. This review summarizes the current development of clinical treatments of ReA with biological agents, which provides future investigations on refractory ReA with more evidence and references.
Collapse
|
10
|
Rosine N, Miceli-Richard C. Innate Cells: The Alternative Source of IL-17 in Axial and Peripheral Spondyloarthritis? Front Immunol 2021; 11:553742. [PMID: 33488572 PMCID: PMC7821711 DOI: 10.3389/fimmu.2020.553742] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022] Open
Abstract
Spondyloarthritis (SpA) is a chronic inflammatory rheumatism characterized by inflammation of sacroiliac joints, peripheral joints, and spine. The Assessment of SpondyloArthritis Society describes three disease forms: axial (axSpA), peripheral, and enthesitic SpA. Each may be associated with extra-articular manifestations: psoriasis, inflammatory bowel disease, and acute anterior uveitis. Genome-wide association studies performed in axSpA and psoriatic arthritis (PsA) have shown a shared genetic background, especially the interleukin 23 (IL-23)/IL-17 pathway, which suggests pathophysiological similarities. The convincing positive results of clinical trials assessing the effect of secukinumab and ixekizumab (anti-IL-17A monoclonal antibodies) in axSpA and PsA have reinforced the speculated crucial role of IL-17 in SpA. Nevertheless, and obviously unexpectedly, the differential efficacy of anti-IL-23–targeted treatments between axSpA (failure) and PsA (success) has profoundly disrupted our presumed knowledge of disease pathogeny. The cells able to secrete IL-17, their dependence on IL-23, and their respective role according to the clinical form of the disease is at the heart of the current debate to potentially explain these observed differences in efficacy of IL-23/IL-17–targeted therapy. In fact, IL-17 secretion is usually mainly related to T helper 17 lymphocytes. Nevertheless, several innate immune cells express IL-23 receptor and can produce IL-17. To what extent these alternative cell populations can produce IL-17 independent of IL-23 and their respective involvement in axSpA and PsA are the crucial scientific questions in SpA. From this viewpoint, this is a nice example of a reverse path from bedside to bench, in which the results of therapeutic trials allow for reflecting more in depth on the pathophysiology of a disease. Here we provide an overview of each innate immunity-producing IL-17 cell subset and their respective role in disease pathogeny at the current level of our knowledge.
Collapse
Affiliation(s)
- Nicolas Rosine
- Unité Mixte AP-HP/Institut Pasteur, Institut Pasteur, Immunoregulation Unit, Paris, France
| | - Corinne Miceli-Richard
- Unité Mixte AP-HP/Institut Pasteur, Institut Pasteur, Immunoregulation Unit, Paris, France.,Paris University, Department of Rheumatology-Hôpital Cochin. Assistance Publique-Hôpitaux de Paris, EULAR Center of Excellence, Paris, France
| |
Collapse
|
11
|
Koo BS, Jo S, Kwon E, Shin JH, Hur JW, Kim TH. Effect of biologics in the level of cytokines in the synovial fluid of patients with ankylosing spondylitis. Korean J Intern Med 2020; 35:465-473. [PMID: 31830775 PMCID: PMC7060997 DOI: 10.3904/kjim.2018.364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 01/31/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND/AIMS Biologics are very effective drugs for patients with ankylosing spondylitis (AS). However, there are patients who are not responding to biologics. This study aimed to evaluate the level of tumor necrosis factor α (TNF-α), interleukin (IL)-23, and IL-17 from synovial fluid in patients with AS and rheumatoid arthritis (RA) and differences of the level of those cytokines according to drugs. METHODS Synovial fluid was obtained from 34 patients (42 samples) with AS and 45 patients (47 samples) with RA with active arthritis of the knee, and the cytokine levels were measured. The differences in the levels between patients treated with and without biologics (biologics and non-biologics groups, respectively) were analyzed in AS and RA. The correlations between cytokines were examined in the non-biologics and biologics groups. RESULTS The TNF-α level in AS was significantly lower than that in RA (p = 0.016). The IL-17 and IL-23 levels were not different between AS and RA (p = 0.409 and p = 0.562, respectively). In AS and RA, TNF-α, IL-17, and IL-23 showed good correlation among each other in the non-biologics group. However, there was no significant correlation in biologics group. In some patients in the AS group, the IL-17 or IL-23 level was markedly elevated in the biologics group. CONCLUSION Treatment with biologics affects the cytokine profile in inflammatory synovial fluid in patients with both AS and RA. Furthermore, IL-23 and IL-17 cytokine might be an important factor in some patients who are unresponsive to biologics in AS.
Collapse
Affiliation(s)
- Bon San Koo
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Sungsin Jo
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Eunji Kwon
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Ji Hui Shin
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Jin-Wuk Hur
- Division of Rheumatology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Correspondence to Tae-Hwan Kim, M.D. Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea Tel: +82-2-2290-9245 Fax: +82-2-2298-8231 E-mail:
| |
Collapse
|
12
|
Dubey D, Kumar S, Chaurasia S, Guleria A, Ahmed S, Singh R, Kumari R, Modi DR, Misra R, Kumar D. NMR-Based Serum Metabolomics Revealed Distinctive Metabolic Patterns in Reactive Arthritis Compared with Rheumatoid Arthritis. J Proteome Res 2018; 18:130-146. [PMID: 30376345 DOI: 10.1021/acs.jproteome.8b00439] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Reactive arthritis (ReA) is a member of seronegative spondyloarthropathy (SSA), which involves an acute/subacute onset of asymmetrical lower limb joint inflammation weeks after a genitourinary/gastrointestinal infection. The diagnosis is clinical because it is difficult to culture the microbes from synovial fluid. Arthritis patients with a similar clinical picture but lapsed history of an immediate preceding infection that do not fulfill the diagnostic criteria of other members of SSA, such as ankylosing spondylitis, psoriatic arthritis, and arthritis associated with inflammatory bowel disease, are labeled as peripheral undifferentiated spondyloarthropathy (uSpA). Both ReA and uSpA patients show a strong association with class I major histocompatibility complex allele, HLA-B27, and a clear association with an infectious trigger; however, the disease mechanism is far from clear. Because the clinical picture is largely dominated by rheumatoid-arthritis (RA)-like features including elevated levels of inflammatory markers (such as ESR, CRP, etc.), these overlapping symptoms often confound the clinical diagnosis and represent a clinical dilemma, making treatment choice more generalized. Therefore, there is a compelling need to identify biomarkers that can support the diagnosis of ReA/uSpA. In the present study, we performed NMR-based serum metabolomics analysis and demonstrated that ReA/uSpA patients are clearly distinguishable from controls and further that these patients can also be distinguished from the RA patients based on the metabolic profiles, with high sensitivity and specificity. The discriminatory metabolites were further subjected to area under receiver operating characteristic curve analysis, which led to the identification of four metabolic entities (i.e., valine, leucine, arginine/lysine, and phenylalanine) that could differentiate ReA/uSpA from RA.
Collapse
Affiliation(s)
- Durgesh Dubey
- Babasaheb Bhimrao Ambedkar University , Lucknow 226025 , India
| | | | | | | | | | - Rajeev Singh
- National Institute of Virology , Gorkhpur Unit , BRD Medical College Campus , Gorakhpur 273013 , India.,Department of Biochemistry , KGMU , Lucknow 226003 , India
| | - Reena Kumari
- Department of Biochemistry , KGMU , Lucknow 226003 , India
| | - Dinesh Raj Modi
- Babasaheb Bhimrao Ambedkar University , Lucknow 226025 , India
| | | | | |
Collapse
|
13
|
Babaie F, Hasankhani M, Mohammadi H, Safarzadeh E, Rezaiemanesh A, Salimi R, Baradaran B, Babaloo Z. The role of gut microbiota and IL-23/IL-17 pathway in ankylosing spondylitis immunopathogenesis: New insights and updates. Immunol Lett 2018; 196:52-62. [DOI: 10.1016/j.imlet.2018.01.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/16/2018] [Accepted: 01/31/2018] [Indexed: 12/16/2022]
|
14
|
Raychaudhuri SP, Raychaudhuri SK. Mechanistic rationales for targeting interleukin-17A in spondyloarthritis. Arthritis Res Ther 2017; 19:51. [PMID: 28270233 PMCID: PMC5341175 DOI: 10.1186/s13075-017-1249-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The term spondyloarthritis (SpA) is used to describe a group of inflammatory autoimmune diseases, including ankylosing spondylitis and psoriatic arthritis, with common genetic risk factors and clinical features. SpA is clinically distinct from rheumatoid arthritis and typically affects the spine, sacroiliac joints, entheses, and, less commonly, peripheral joints. Although the pathogenesis of SpA is not fully understood, recent findings have identified the interleukin (IL)-17 pathway as a key mediator of disease pathogenesis. Clinical evidence for the efficacy of IL-17A inhibition by biologic agents was initially shown in patients with chronic plaque psoriasis, another autoimmune disease mediated by the IL-17 pathway. Subsequently, similar positive efficacy for inhibition of IL-17A was seen in patients with ankylosing spondylitis and psoriatic arthritis. Inhibition of IL-17A may also improve cardiovascular and metabolic comorbidities often found in patients with SpA because studies have linked these disorders to the IL-17 pathway. In this review, we will examine key preclinical studies that demonstrated the mechanistic role of IL-17A in the development SpA and discuss how these observations were translated into clinical practice.
Collapse
Affiliation(s)
- Siba P Raychaudhuri
- VA Medical Center Sacramento, Division of Rheumatology & Immunology, Sacramento, CA, USA. .,Division of Rheumatology, Allergy & Clinical immunology, University of California School of Medicine, Davis, & VA Medical Center Sacramento, Sacramento, CA, USA.
| | - Smriti K Raychaudhuri
- VA Medical Center Sacramento, Division of Rheumatology & Immunology, Sacramento, CA, USA
| |
Collapse
|
15
|
Eliçabe RJ, Silva JE, Dave MN, Lacoste MG, Tamashiro H, Blas R, Munarriz A, Rabinovich GA, Di Genaro MS. Association between IL-17 and IgA in the joints of patients with inflammatory arthropathies. BMC Immunol 2017; 18:8. [PMID: 28166724 PMCID: PMC5292804 DOI: 10.1186/s12865-017-0189-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/17/2017] [Indexed: 02/07/2023] Open
Abstract
Background Hyperactive secretion and pathogenic effects of interleukin (IL)-17 and IgA have been detected in different arthropathies. Recent evidence has revealed that TH17 cytokines regulate mucosal IgA secretion. However, it is unknown whether and how IL-17 mediates synovial IgA production. Here we aim to investigate the connection of synovial IL-17 with IgA production in the joint. In this study we included synovial fluids (SF) from patients with rheumatoid arthritis (RA; n = 66), spondyloarthritis (SpA; n = 18) and osteoarthritis (OA; n = 36). The levels of IL-17, IL-6, transforming growth factor (TGF)-β1, B-cell-activating factor of the TNF family (BAFF) and anti-lipopolyssacharide (LPS) immunoglobulin (Ig)A were investigated by enzyme-linked immunosorbent assay (ELISA). Total IgA was measured by radial immunodiffusion assay. Synovial fluid-derived mononuclear cells (SFMC) were stimulated with bacterial antigens or SF-conditioned media, and cytokines and IgA were analyzed in the supernatants. Results IL-17, IL-6 and TGF-β1 were increased in SF from both RA and SpA compared with OA patients. Concentration of IL-17 correlated with the disease activity score (DAS)-28, IL-6 and anti-LPS IgA levels. Bacterial-stimulated SFMCs from RA and SpA patients secreted higher IL-17 than vehicle-stimulated SFMCs. Conditioned media with SF containing IL-17 induced anti-LPS IgA production by SFMCs which was independent of IL-6 activity. Concentrations of synovial TGF-β1 and BAFF correlated with anti-LPS and total IgA levels, respectively. Blockade of IL-17 decreased the production of TGF-β1 and anti-LPS IgA by SF-stimulated SFMCs. Conclusions This study reports a connection between IL-17 and IgA secretion in the joint. In addition, it demonstrates that enterobacterial antigens trigger synovial IL-17 production, and that TGF-β1 and BAFF may mediate the effect of IL-17 on IgA production. This circuit may contribute to the pathogenesis of inflammatory joint diseases.
Collapse
Affiliation(s)
- Ricardo Javier Eliçabe
- Division of Immunology, Faculty of Chemistry, Biochemistry and Pharmacy, National University of San Luis, Ejército de los Andes 950, San Luis, Argentina.,Laboratory of Immunopathology, Multidisciplinary Institute of Biological Investigations - San Luis (IMIBIO-SL), National Council of Scientific and Technical Investigations (CONICET), Ejército de los Andes 950, San Luis, 5700, Argentina
| | - Juan Eduardo Silva
- Division of Immunology, Faculty of Chemistry, Biochemistry and Pharmacy, National University of San Luis, Ejército de los Andes 950, San Luis, Argentina.,Laboratory of Immunopathology, Multidisciplinary Institute of Biological Investigations - San Luis (IMIBIO-SL), National Council of Scientific and Technical Investigations (CONICET), Ejército de los Andes 950, San Luis, 5700, Argentina
| | - Mabel Noemí Dave
- Division of Immunology, Faculty of Chemistry, Biochemistry and Pharmacy, National University of San Luis, Ejército de los Andes 950, San Luis, Argentina.,Laboratory of Immunopathology, Multidisciplinary Institute of Biological Investigations - San Luis (IMIBIO-SL), National Council of Scientific and Technical Investigations (CONICET), Ejército de los Andes 950, San Luis, 5700, Argentina
| | - María Gabriela Lacoste
- Division of Immunology, Faculty of Chemistry, Biochemistry and Pharmacy, National University of San Luis, Ejército de los Andes 950, San Luis, Argentina.,Laboratory of Immunopathology, Multidisciplinary Institute of Biological Investigations - San Luis (IMIBIO-SL), National Council of Scientific and Technical Investigations (CONICET), Ejército de los Andes 950, San Luis, 5700, Argentina
| | - Héctor Tamashiro
- Private Medical Clinic Bolivar, Bolivar 1277, San Luis, 5700, Argentina
| | - Rodrigo Blas
- Medical Clinic Medici, Ayacucho 1118, San Luis, 5700, Argentina
| | | | - Gabriel Adrián Rabinovich
- Laboratory of Immunopathology, Institute of Biology and Experimental Medicine (IBYME), CONICET, Vuelta de Obligado 2490, Buenos Aires, C1428A, Argentina.,Faculty of Exact and Natural Sciences, University of Buenos Aires, Intendente Güiraldes 2160, Buenos Aires, C1428EGA, Argentina
| | - María Silvia Di Genaro
- Division of Immunology, Faculty of Chemistry, Biochemistry and Pharmacy, National University of San Luis, Ejército de los Andes 950, San Luis, Argentina. .,Laboratory of Immunopathology, Multidisciplinary Institute of Biological Investigations - San Luis (IMIBIO-SL), National Council of Scientific and Technical Investigations (CONICET), Ejército de los Andes 950, San Luis, 5700, Argentina.
| |
Collapse
|
16
|
Maldonado-Ficco H, Perez-Alamino R, Maldonado-Cocco JA. Secukinumab: a promising therapeutic option in spondyloarthritis. Clin Rheumatol 2016; 35:2151-61. [PMID: 27437696 DOI: 10.1007/s10067-016-3350-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/02/2016] [Accepted: 07/04/2016] [Indexed: 12/14/2022]
Abstract
Psoriatic arthritis (PsA) is the second most common chronic inflammatory joint disease. Ankylosing spondylitis (AS) is another less common but equally chronic and disabling spondyloarthritis (SpA). Therapeutic agents for the treatment of these diseases have been somewhat lacking as compared with those available for rheumatoid arthritis, which represents a significant challenge for both the treating physician and the pharmaceutical industry. A promising development for our understanding of the physiopathology of PsA and AS involves new targets to interrupt IL-17 and IL-12/IL-23 pathways. Up to 30-40 % of SpA patients have inadequate or poor response, or are intolerant to anti-TNF therapies. Therefore, there has been a clear unmet medical need in an important group of these patients. As a result, new therapeutic targets have emerged for the treatment of both axial and peripheral SpA. Interleukin 17 (IL-17) is a pro-inflammatory cytokine that is increased in psoriatic lesions as well as in the synovial fluid of patients with PsA and in sites of enthesitis in SpA. IL-23 has been shown to play an important role in the polarization of CD4+ T-cells to become IL-17 producers. Based on these evidences, blockade of the cytokine IL-17 or its receptors was considered to have therapeutic implications for the treatment of psoriasis, as well as PsA and AS.This article presents a thorough review of an IL-17 A blocking agent, its mechanism of action, its clinical efficacy and its therapeutic safety.
Collapse
Affiliation(s)
- Hernan Maldonado-Ficco
- Rheumatology Section, Department of Internal Medicine, Hospital San Antonio de Padua, Cordoba, Río Cuarto, Argentina.
| | - Rodolfo Perez-Alamino
- Rheumatology Section, Department of Internal Medicine, Hospital Avellaneda, Tucumán, Argentina
| | - José A Maldonado-Cocco
- University of Buenos Aires, Buenos Aires, Argentina.,Rheumatology Training Program, Buenos Aires University School of Medicine, Buenos Aires, Argentina
| |
Collapse
|
17
|
Chaurasia S, Shasany AK, Aggarwal A, Misra R. Recombinant Salmonella typhimurium outer membrane protein A is recognized by synovial fluid CD8 cells and stimulates synovial fluid mononuclear cells to produce interleukin (IL)-17/IL-23 in patients with reactive arthritis and undifferentiated spondyloarthropathy. Clin Exp Immunol 2016; 185:210-8. [PMID: 27060348 DOI: 10.1111/cei.12799] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 01/21/2023] Open
Abstract
In developing countries, one-third of patients with reactive arthritis (ReA) and undifferentiated spondyloarthropathy (uSpA) are triggered by Salmonella typhimurium. Synovial fluid mononuclear cells (SFMCs) of patients with ReA and uSpA proliferate to low molecular weight fractions (lmwf) of outer membrane proteins (Omp) of S. typhimurium. To characterize further the immunity of Omp of Salmonella, cellular immune response to two recombinant proteins of lmwf, OmpA and OmpD of S. typhimurium (rOmpA/D-sal) was assessed in 30 patients with ReA/uSpA. Using flow cytometry, 17 of 30 patients' SF CD8(+) T cells showed significant intracellular interferon (IFN)-γ to Omp crude lysate of S. typhimurium. Of these 17, 11 showed significantly more CD8(+) CD69(+) IFN-γ T cells to rOmpA-sal, whereas only four showed reactivity to rOmpD-sal. The mean stimulation index was significantly greater in rOmpA-sal than rOmpD-sal [3·0 (1·5-6·5) versus 1·5 (1·0-2·75), P < 0·005]. Similarly, using enzyme-linked immunospot (ELISPOT) in these 17 patients, the mean spots of IFN-γ-producing SFMCs were significantly greater in rOmpA-sal than rOmpD-sal [44·9 (3·5-130·7) versus 19·25 (6-41), P < 0·05]. SFMCs stimulated by rOmpA-sal produced significantly more proinflammatory cytokines than rOmpD-sal: IFN-γ [1·44 (0·39-20·42) versus 0·72 (0·048-9·15) ng/ml, P < 0·05], interleukin (IL)-17 [28·60 (6·15-510·86) versus 11·84 (6·83-252·62) pg/ml, P < 0·05], IL-23 [70·19 (15-1161·16) versus 28·25 (> 15-241·52) pg/ml, P < 0·05] and IL-6 [59·78 (2·03-273·36) versus 10·17 (0·004-190·19) ng/ml, P < 0·05]. The rOmpA-sal-specific CD8(+) T cell response correlated with duration of current synovitis (r = 0·53, P < 0·05). Thus, OmpA of S. typhimurium is a target of SF CD8(+) T cells and drives SFMC to produce increased cytokines of the IL-17/IL-23 axis which contribute to the pathogenesis of Salmonella-triggered ReA.
Collapse
Affiliation(s)
- S Chaurasia
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences
| | - A K Shasany
- Biotechnology Division, Central Institute of Medicinal and Aromatic Plants, Lucknow, India
| | - A Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences
| | - R Misra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences
| |
Collapse
|
18
|
IL-23/IL-17 axis in spondyloarthritis-bench to bedside. Clin Rheumatol 2016; 35:1437-41. [DOI: 10.1007/s10067-016-3263-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 02/27/2016] [Accepted: 02/28/2016] [Indexed: 01/13/2023]
|
19
|
Inflammatory bowel disease-related arthritis - clinical evaluation and possible role of cytokines. Reumatologia 2015; 53:236-42. [PMID: 27407253 PMCID: PMC4847320 DOI: 10.5114/reum.2015.55824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 10/24/2015] [Indexed: 01/31/2023] Open
Abstract
Objectives In inflammatory bowel disease (IBD), characterized by chronic mucosal inflammation, rheumatic abnormalities ranging from arthralgia to spondyloarthritis (SpA) are the most common extraintestinal manifestations. The pathogenesis of IBD-related arthritis is unclear. In this study, we search for clinical and immunological differences between patients with IBD-associated spondyloarthritis and IBD patients without SpA symptoms. Material and methods Patients with an established diagnosis of IBD, suffering from Leśniowski-Crohn disease (L-CD, n = 24) or ulcerative colitis (UC, n = 27), were enrolled in the study. Clinical evaluation of patients, based on medical history, blood tests, physical and radiological examinations, allowed two subgroups of patients to be established. One subgroup comprised patients fulfilling criteria for both IBD and SpA (IBD + SpA, n = 29), while the other included IBD patients with arthralgia only (IBD, n = 22). Serum concentrations of interleukins (IL-6, IL-10, IL-21, IL-22, IL-23) and interferon γ (IFN-γ) were measured by specific enzyme-linked immunosorbent assays (ELISA). Results Patients with IBD + SpA were characterized by shorter disease duration (3 vs. 9 years), higher frequency of HLA-B27 positivity (60.7% vs. 4.5%) and uveitis (20.7% vs. 0%), compared with the IBD subgroup. The serum concentrations of C-reactive protein (CRP) and tested cytokines did not differ between IBD + SpA and IBD patients, or between L-CD and UC groups. However, in the IBD + SpA subgroup there was weak to moderate positive correlation between serum concentrations of CRP and several cytokines (IL-6, IL-21, IFN-γ), and additional moderate positive correlation between serum concentrations of IL-23 and clinical activity of SpA. By contrast, in IBD subgroup a strong inverse correlation between serum concentrations of Interleukin 23 and CRP was found. Conclusions IBD-related spondyloarthritis occurs relatively early, affects mostly HLA-B27(+) individuals, and is often accompanied by ocular involvement. In these patients several circulating cytokines are associated with systemic inflammation. IL-23 seems to be protective in IBD while detrimental in IBD-related spondyloarthritis.
Collapse
|
20
|
Serum IL-6 and IL-23 Levels and Their Correlation with Angiogenic Cytokines and Disease Activity in Ankylosing Spondylitis, Psoriatic Arthritis, and SAPHO Syndrome. Mediators Inflamm 2015; 2015:785705. [PMID: 26339141 PMCID: PMC4539212 DOI: 10.1155/2015/785705] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/15/2015] [Accepted: 03/22/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To assess serum interleukin-6 (IL-6) and interleukin-23 (IL-23) and their correlation with angiogenic cytokines and disease activity in ankylosing spondylitis (AS), psoriatic arthritis (PsA), and SAPHO syndrome. PATIENTS AND METHODS We studied 152 spondyloarthritis (SpA) patients: 69 PsA, 61 AS, 22 SAPHO, and 29 controls. We recorded age, sex, disease duration, and treatment. We assessed BASDAI, VAS, and PASI scores. Serum IL-6, IL-23, VEGF, EGF, FGFb, and FGFa levels were determined using ELISA. We estimated ESR and CRP. RESULTS Serum IL-6 and IL-23 levels were higher in SpA than in control (P < 0.00001 and P = 0.0004, resp.). There was a positive correlation between serum IL-6 and CRP in AS (P = 0.000001), PsA (P = 0.000001), and SAPHO (P = 0.0003) patients. There was a positive correlation between serum IL-6 and ESR in AS (P = 0.000001), PsA (P = 0.002), and SAPHO (P = 0.02) patients. There was no correlation of serum IL-6 and IL-23 with VAS, BASDAI, and angiogenic cytokines in SpA. CONCLUSIONS Serum IL-6 but not serum IL-23 correlated with ESR and CRP in SpA. No correlation was found of serum IL-6 and IL-23 with VAS, BASDAI, and angiogenic cytokines.
Collapse
|
21
|
Raychaudhuri SK, Saxena A, Raychaudhuri SP. Role of IL-17 in the pathogenesis of psoriatic arthritis and axial spondyloarthritis. Clin Rheumatol 2015; 34:1019-23. [PMID: 25939522 DOI: 10.1007/s10067-015-2961-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 03/12/2015] [Indexed: 12/31/2022]
Abstract
Th17 cells are a discrete subset of T cell subpopulation, which produce IL-17 and certain other pro-inflammatory cytokines. A regulatory role of Th17 cells have been proposed in several autoimmune diseases including psoriasis, psoriatic arthritis (PsA), ankylosing spondylitis (AS), rheumatoid arthritis, inflammatory bowel disease, systemic lupus erythematosus, and multiple sclerosis. Psoriatic disease is an autoimmune disease which mainly involves skin and joints. Until recently, psoriasis and PsA were thought to be Th1 mediated disease, but after the discovery of IL-17 and IL-17 knockout animal studies as well as human experimental data indicate a crucial role of the Th17 cells in the pathogenesis of psoriasis and PsA. Our research group have not only found abundance of CD4(+)IL-17(+) T cells, mainly the memory phenotype (CD4RO(+)CD45RA(-)CD11a(+)) in the synovial fluid, but also have shown the existence of a functional IL-17 receptor in synovial fibroblast of psoriatic arthritis patients. Similarly, both animal and human studies indicate a regulatory role of the Th17 cells in AS; most critical observations are that Th17 cytokines (IL-17 and IL-22) can contribute to bone erosion, osteitis and new bone formation the hall mark skeletal features associated with the pathophysiology of AS. In this review article, we have discussed the contributing role of the IL-23/IL-17 axis in the pathogenesis of PsA and AS.
Collapse
|
22
|
Eliçabe RJ, Genaro MSD. Immunopathogenesis of reactive arthritis: Role of the cytokines. World J Immunol 2014; 4:78-87. [DOI: 10.5411/wji.v4.i2.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 05/24/2014] [Accepted: 06/16/2014] [Indexed: 02/05/2023] Open
Abstract
Reactive arthritis (ReA), also known as sterile postinfectious arthritis, belongs to the group of related arthropathies known as spondyloarthritis (SpA). ReA can arise 1-4 wk after a gastrointestinal or genitourinary infection, but once arthritis develops, the microorganism is not found in the joint. The classical microbes associated with ReA development include Gram-negative aerobic or microaerophilic bacteria containing LPS in their outer membrane. The immunopathogenic mechanisms involved in ReA development are still unknown. A hypothesis suggested that the bacteria probably persist outside the joint, at sites such as gut mucosa or lymph nodes, and bacterial antigens might then be transported to the joints. On the other hand, an altered immune response and the unbalanced production of cytokines have been reported in subjects with ReA. Currently, there is increased evidence to suggest that both mechanisms would operate in the immunopathogenesis of ReA. In this review we highlight recent advances on the role of cytokines in the ReA. Particularly, we discuss the roles of some pro- and anti-inflammatory cytokines involved in the immunopathogenesis of ReA.
Collapse
|
23
|
Lee AYS, Körner H. CCR6 and CCL20: emerging players in the pathogenesis of rheumatoid arthritis. Immunol Cell Biol 2014; 92:354-8. [DOI: 10.1038/icb.2013.97] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/18/2013] [Accepted: 11/18/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Adrian YS Lee
- Menzies Research Institute Tasmania, University of TasmaniaHobartTasmaniaAustralia
- School of Medicine, University of TasmaniaHobartTasmaniaAustralia
| | - Heinrich Körner
- Menzies Research Institute Tasmania, University of TasmaniaHobartTasmaniaAustralia
| |
Collapse
|
24
|
Välimäki E, Aittomäki S, Karenko L, Kantonen J, Pettersson T, Turunen U, Matikainen S, Leirisalo-Repo M, Repo H. Normal inflammasome activation and low production of IL-23 by monocyte-derived macrophages from subjects with a history of reactive arthritis. Scand J Rheumatol 2013; 42:294-8. [PMID: 23425136 DOI: 10.3109/03009742.2012.754940] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The pathogenesis of reactive arthritis (ReA) is incompletely understood but may involve aberration(s) in the host's innate immune response towards infecting microbes. We therefore studied the production of interleukin (IL)-1β, a marker of inflammasome activation, and of IL-6, IL-12, IL-23, and tumour necrosis factor (TNF)-α, promoters of T-cell differentiation, by peripheral blood mononuclear cells (PBMNs) and monocyte-derived macrophages from healthy subjects with a history of ReA. METHOD The study included 10 human leucocyte antigen (HLA)-B27-positive healthy subjects with previous ReA triggered by Yersinia enterocolitica O:3 infection and 20 healthy reference subjects, of whom 10 were HLA-B27 positive. PBMNs and macrophages were cultured for 18 h with bacterial lipopolysaccharide (LPS), muramyl dipeptide (MDP), Yersinia, or their appropriate combinations. PBMNs were also stimulated with monosodium urate (MSU) crystals. Cytokine levels were measured using an enzyme-linked immunosorbent assay (ELISA) and the Luminex system. RESULTS IL-1β secretion was similar from cells of the ReA group and from the HLA-B27-positive and -negative reference groups. TNF-α production from macrophages upon co-stimulation of LPS and MDP increased in the order ReA group < HLA-B27-positive reference group < HLA-B27-negative reference group (p for a trend = 0.027). Similarly, Yersinia-induced TNF-α and IL-23 production increased in the same order (p for trend for TNF-α = 0.036; p for trend for IL-23 = 0.026). CONCLUSIONS PBMNs and macrophages from healthy subjects with previous ReA show normal inflammasome activation and low TNF-α and IL-23 production. This low cytokine production may impair bacterial elimination and thereby contribute to the triggering of ReA.
Collapse
Affiliation(s)
- E Välimäki
- Unit of Immunotoxicology, Finnish Institute of Occupational Health, Helsinki, Finland.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Current world literature. Curr Opin Rheumatol 2012; 24:435-40. [PMID: 22653148 DOI: 10.1097/bor.0b013e3283556515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
26
|
Salmonella enterica induces joint inflammation and expression of interleukin-17 in draining lymph nodes early after onset of enterocolitis in mice. Infect Immun 2012; 80:2231-9. [PMID: 22493084 DOI: 10.1128/iai.00324-12] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
In developing countries, one-third of reactive arthritis (ReA) cases are associated with Salmonella enterocolitis; nevertheless, there is no animal model for studying this pathology. Here we induced a self-limiting Salmonella enterica serovar Enteritidis enterocolitis in mice to analyze the onset of ReA. BALB/c mice received orally 20 μg of streptomycin 24 h before intragastric inoculation of a low dose (3 × 10(3) to 4 × 10(3) CFU) of S. Enteritidis. In response to Salmonella infection, a 30-fold increase in the expression of interleukin-17 (IL-17), measured by quantitative PCR, was observed in mesenteric lymph nodes 5 days postinfection. At this time synovitis was already evident, and concomitantly, a significant increase in joint tumor necrosis factor alpha (TNF-α) was detected by enzyme-linked immunosorbent assay (ELISA). The early development of joint lesions was accompanied by an increased expression of IL-17 in inguinal and popliteal lymph nodes. Infection with 10(7) CFU of an isogenic ΔinvG mutant bearing a defective type III secretion system of Salmonella encoded in the pathogenicity island 1 apparatus (TTSS-1) induced enterocolitis histologically similar to that triggered by the wild-type strain. Interestingly, despite the higher infective dose used, the mutant did not trigger intestinal IL-17. Moreover, no synovitis was observed in mice suffering ΔinvG enterocolitis. Neutralization of IL-17 in mice infected with S. Enteritidis prevented both synovitis and the increment of TNF-α in the joints, suggesting that IL-17 participates in the generation of Salmonella-induced ReA through the induction of TNF-α in the joints.
Collapse
|
27
|
Mrabet D, Laadhar L, Sahli H, Zouari B, Haouet S, Makni S, Sellami S. Synovial fluid and serum levels of IL-17, IL-23, and CCL-20 in rheumatoid arthritis and psoriatic arthritis: a Tunisian cross-sectional study. Rheumatol Int 2011; 33:265-6. [DOI: 10.1007/s00296-011-2231-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 10/22/2011] [Indexed: 02/04/2023]
|
28
|
Yuan FL, Li X, Sun JM, Xu RS. Emerging role of IL-23 in rheumatoid arthritis. Clin Rheumatol 2011; 30:1135-6. [DOI: 10.1007/s10067-011-1801-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 06/08/2011] [Indexed: 11/29/2022]
|