The effect of Iguratimod combined with Etanercept on CD4+, CD8+T cells and immunoglobulin of patients with refractory rheumatoid arthritis

LI Xuerong; CHEN Yongping; ZHANG Bangshuo; CHEN Jing; XU Hui; WANG Sheng; ZHANG Chuanrong; YANG Yi

doi:10.13431/j.cnki.immunol.j.20180021

Abstract：Rheumatoid arthritis (RA) is a chronic autoimmune disease that destroys the synovial membrane,cartilage and bone in the joint.The occurrence of this disease may be related to autoantibodies and antigen antibody complexes infiltrating synovium,activation of tumor necrosis factor-alpha (TNF-alpha) and other inflammatory cytokines,resulting in destruction of articular cartilage and bone.This study was performed to evaluate the immune mechanism of action of Iguratimod combined with Etanercept in the treatment of refractory rheumatoid arthritis (RRA).Total of 60 patients with RRA were randomly divided into experimental group and control group,with 30 patients in each group.The experimental group was gave Iguratimod orally (25 mg per time,twice daily) and Etanercept subcutaneously (25 mg per time,twice a week),while control group was treated with Etanercept subcutaneously (25 mg per time,twice a week) for 12 weeks.And then,the levels of CD4+T cells,CD8+T cells and CD4 +/CD8 + were detected by four-color flow cytometry,and the levels of immunolobulins were measured by immunoturbidimetry before and after treatment;the activity score of rheumatoid arthritis (RA) before and after treatment was calculated,and C reactive protein and rheumatoid factor were detected.Data showed that after 12 weeks treatment,the experimental group demonstrated higher levels of CD4+T cells and CD4+/CD8+ (P＜0.05),lower level of immunoglobulin (P＜0.05),as compared with control group.There was no differences in CD8+T cells before and after treatment in both groups (P＞ 0.05);no significant difference in adverse reaction was found between the two groups (P＞0.05).DAS28,ESR,CPR and RF indicators were decreased after treatment (P＜0.05) in the two groups of patients.After the treatment,IgG,IgA and IgM indicators of experimental group were lower than those in the control group (P＜0.05).Taken together,the mechanism of Iguratimod combined Etanercept treatment against refractory rheumatoid may relates with adjusting the immune imbalance of CD4+/CD8+T cells and downregulating immunoglobulin.