The Influence of Anti–CD20 Therapy  on Some Immunological Parameters in  patients with Rheumatoid Arthritis

Dr. Batool Hassan Al- Ghurabi

Volume : II, Issue : VIII, August - 2013

The Influence of Anti–CD20 Therapy on Some Immunological Parameters in patients with Rheumatoid Arthritis

Dr. Batool Hassan Al Ghurabi

Abstract :

Background: Rheumatoid arthritis (RA) is a chronic systemic immune mediated disease that results in significant morbidity and crippling effects. Recently a prominent role for B cells in the pathogenesis of RA has been confirmed, and it has been shown that anti-B cell therapy is a powerful tool in the treatment of RA. Aims of the study: To assess the effect of rituximab (anti-CD20) treatment on the levels of autoantibodies [rheumatoid factor (RF-IgM) and anti-cyclic citrullinated peptide (ACCP- IgG)], and cytokines profile (IL-1α, IL-8, IL-17 and GM-CSF) in patients with RA. Subjects and Methods: This study included 65 patients with RA, of these, 35 were patients without treatment, represent untreated patients group, the remaining group consist of 30 patients were treated with rituximab therapy, represent treated patients group, and 25 healthy individuals as controls group. ACCP and cytokines levels in serum were measured by enzyme linked immunosorbent assay, while serum RF was estimated by agglutination test. Results: Compared to healthy control group untreated patients group have shown significantly higher (p<0.01) seroprevalence of (RF and ACCP), and higher levels of IL-1α, IL-8, IL-17 and GM-CSF.On the other hand, patients group treated with rituximab showed significant (p<0.05) decrease in seroprevalence of RF and ACCP, and in levels IL-1α and IL-17, but not in levels of IL-8 and GM-CSF when compared to untreated patients group. Interestingly, in treated patients group significant correlations of serum IL-1 α and IL-17 levels were found with each of DAS and RF. Conclusion: The current data indicate that anti-CD20 therapy not only neutralizes the effects of B-cell, but it also down-regulates the proinflammatory interleukins like IL-1α and IL-17 in RA patients. In addition these findings showed that cytokines can be used to predict the response to rituximab in patients with refractory RA.