Abstract
Rheumatoid arthritis is a complex inflammatory disease of unknown cause. Although various laboratory and clinical measurements are useful in managing these patients, there is a need for better tests to quantitatively assess disease activity. The purpose of this study was to investigate the association of certain immune and inflammation (I-I) parameters with four traditional disease severity measures and a functional measure in rheumatoid arthritis patients. A single set of patient blood samples was analyzed, and four traditional disease severity measures and patient functional statuses were determined from 64 consecutive outpatients with rheumatoid arthritis. Plasma tumor necrosis factor-alpha (TNF), soluble interleukin-2 receptor (sIL-2R), sCD4 and sCD8 (and the sCD4/sCD8 ratio), neopterin, and fibrin D-dimer were analyzed in relationship to Westergren erythrocyte sedimentation rate (ESR), physician assessment of disease activity, joint pain count, grip strength, and Arthritis Impact Measurement Scale (AIMS) scores. Rheumatoid arthritis patients had higher mean levels of all I-I measures (except sCD4) compared to healthy subjects. Initial significant correlations between TNF, sIL-2R, and D-dimer and several disease severity and functional measures were detected. When we controlled for the covariates age, gender, race, and medications, regression analyses indicated that, as a group, the I-I measures were significantly related to grip strength, physician disease severity rating, ESR, and total joint pain. When the predictive values of the I-I measures were tested controlling for the covariates and ESR, D-dimer was independently and significantly associated with variability in grip strength, physician disease severity, and AIMS physical disability, while TNF was associated with a significant amount of variability in total joint pain. The results indicate that these immune and inflammation parameters may be significantly elevated in rheumatoid arthritis patients and that certain measures (e.g., plasma fibrin D-dimer) may be especially useful in objectively evaluating disease activity in RA patients.
Similar content being viewed by others
References
Olsen NJ: Assessment of disease activity in rheumatoid arthritis. Curr Opin Rheum 1:21–28, 1989
Gay S, Koopman WJ: Immunopathology of rheumatoid arthritis. Curr Opin Rheum 1:8–14, 1989
Philip R, Epstein LB: Tumour necrosis factor as immunomodulator and mediator of monocyte cytotoxicity induced by itself, gamma-interferon and interleukin-1. Nature 323:86–89, 1986
Dayer JM, Beutler B, Cerami A: Cachectin/tumor necrosis factor (TNF) stimulates collagenase and PGE2 production by human synovial cells and dermal fibroblasts. J Exp Med 162:2163–2168, 1985
Klebanoff SJ, Vadas MA, Harlan JM, Sparks LH, Gamble JR, Agosti JM, Waltersdorph AM: Stimulation of neutrophils by tumor necrosis factor. J Immunol 136:4220–4225, 1986
Djeu JY, Blanchard DK, Halkias D, Fiedman H: Growth inhibition of Candida albicans by human polymorphonuclear neutrophils: Activation by interferon-gamma and tumor necrosis factor. J Immunol 137:2980–2984, 1986
Tsujimoto M, Yokota S, Vilcek J, Weissmann G: Tumor necrosis factor provokes superoxide anion generation from neutrophils. Biochem Biophys Res Commun 137:1094–1100, 1986
Chin JE, Lin Y: Effects of recombinant human interleukin-1-beta on rabbit articular chondrocytes: Stimulation of prostanoid release and inhibition of cell growth. Arth Rheum 31:1290–1296, 1988
Vilcek J, Palombella VJ, Henriksen-DeStefano D, Swenson C, Feinman R, Hirai M, Tsujimoto M: Fibroblast growth enhancing activity of tumor necrosis factor and its relationship to other polypeptide growth factors. J Exp Med 163:632–643, 1986
Balderas RS, Josimovic-Alasevic O, Diamantstein T, Dixon FJ, Theofilopoulos AN: Elevated titers of cell-free interleukin 2 receptor in serum of lupus mice. J Immunol 139:1496–1500, 1987
Symons JA, Wood NC, S DGF, Duff GW: Soluble IL-2 receptor in rheumatoid arthritis: Correlation with disease activity, IL-1 and IL-2 inhibition. J Immunol 141:2612–2618, 1988
Lasky HP, Bauer K, Poper RM: Increased helper inducer and decreased suppressor inducer phenotypes in the rheumatoid joints. Arth Rheum 31:52–59, 1988
Pitzalis C, Kingley G, Murphy J, Panayi G: Abnormal distribution of the helper-inducer and suppressor-induced T-lymphocyte subsets in the rheumatoid joint. Clin Immunol Immunopathol 45:252–258, 1987
Blue ML, Hafler DA, Daley JF, Levine H, Craig KA, Breitmeyer JB, Schlossman SF: Regulation of T cell clone function via CD4 and CD8 molecules: Anti-CD4 can mediate two distinct inhibitory activities. J Immunol 140:76–383, 1988
Fleischer B, Schrezenmeier H, Wagner H: Function of the CD4 and CD8 molecules on human cytotoxic T lymphocytes: Regulation of T cell triggering. J Immunol 136:1625–1628, 1986
Tomkinson BE, Brown MC, Ip SH, Carrabis S, Sullivan JL: Soluble CD8 during T cell activation. J Immunol 142:2230–2236, 1989
Reibnegger G, Egg D, Fuchs D, Gunther R, Hausen A, Werner ER, Wachter H: Urinary neopterin reflects clinical activity in patients with rheumatoid arthritis. Arth Rheum 29:1063–1070, 1986
Huber C, Batchelor JR, Fuchs D, Hausen A, Lang A, Niederwieser D, Reibnegger G, Swetly P, Troppmair J, Wachter H: Immune response-associated production of neopterin. Release from macrophages primarily under control of interferon-gamma. J Exp Med 160:310–316, 1984
Hannonen P, Tikanoja S, Hakola M, Mottonen T, Viinikka L, Oka M: Urinary neopterin index as a measure of rheumatoid activity. Scand J Rheumatol 15:148–152, 1986
Barnhart M, Riddle J, Bluhm G, Quintana C: Fibrin promotion and lysis in arthritic joints. Ann Rheum Dis 26:206–218, 1967
Clemmensen I, Andersen RB: Properties of fibrinogen-antigenic material on the rheumatoid synovial membrane and in the rheumatoid synovial fluid. J Lab Clin Med 92:678–689, 1978
Clemmensen I, Hølund B, Andersen RB: Fibrin and fibronectin in rheumatoid synovial membrane and rheumatoid synovial fluid. Arth Rheum 26:479–485, 1983
Jasani MK: Fibrin: metabolism, immunopathogenesis and significance in rheumatoid arthritis.In Immunopathogenesis of Rheumatoid Arthritis, GS Pantayi, PM Johnson (eds). Surrey, Reedbooks, 1978, pp 137–146
Colvin RB: Wound healing processes in hemostasis and thrombosis.In Vascular Endothelium in Hemostasis and Thrombosis, MA Gimbrone Jr (eds). New York, Churchill Livingstone, 1986, pp 220–241
Dvorak HF: Tumors: Wounds that do not heal. N Engl J Med 315:1650–1659, 1986
Weinberg JB, Pippen AMM, Greenberg CS: Extravascular fibrin formation and dissolution in synovial tissue of patients with osteoarthritis and rheumatoid arthritis. Arth Rheum 34:996–1005, 1991
Rylatt DB, Blake AS, Cottis LE, Massingham DA, Fletcher WA, Masci PP, Whitaker AN, Elms M, Bunce I, Webber AJ, Wyatt D, Bundesen PG: An immunoassay for human D dimer using monoclonal antibodies. Thromb Res 31:767–768, 1983
Whitaker AN, Elms MJ, Masci PP, Bundesen PG, Rylatt DB, Rylatt JW, Bunce IH: Measurement of cross linked fibrin derivatives in plasma. J Clin Pathol 37:882–887, 1984
Currie M, Vala M, Pisetsky DS, Greenberg CS, Crawford J, Cohen HJ: Correlation between erythrocyte CR1 reduction and other blood proteinase markers in patients with malignant and inflammatory disorders. Blood 75:1699–1704, 1990
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries FJ, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, Medsger TA, Mittchell DM, Neustadt DH, Pinales RS, Schaller JG, Sharpo JT, Wilder RR, Hunder GG: The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arth Rheum 31:315–324, 1988
Kiecolt-Glaser JK: Methodological issues in behavioral immunology research with humans. Brain Behav Immunol 2:67–78, 1988
Anderson JJ, Felson DT, Meenan RF, Williams HJ: Which traditional measures would be used in rheumatoid arthritis clinical trials? Arth Rheum 32:1093–1099, 1989
Williams HJ, Willkens RF, Samuelson DO, Alarcón GS, Guttadauria M, Yarboro C, Pollison RP, Weiner SR, Luggen ME, Billingsley LM, Dahl SL, Egger MJ, Reading JC, Ward JR: Comparison of low-dose oral pulse methotreaxate and placebo in the treatment of rheumatoid arthritis: A controlled clinical trial. Arth Rheum 28:721–730, 1985
Williams HJ, Ward JR, Reading JC, Egger MJ, Grandone JT, Samuelson CO, Furst DE, Sullivan JM, Watson MA, Guttadauria M, Cathcart ES, Kaplan SB, Halla JT, Weinstein A, Plotz PH: Low-dose D-penicillamine therapy in rheumatoid arthritis: A controlled, double-blind clinical trial. Arth Rheum 26:581–592, 1983
Ward JR, Williams HJ, Egger JJ, Reading JC, Boyce E, Altz-Smith M, Samuelson CO, Willkens RF, Solsky MA, Hayes SP, Blocka KL, Weinstein A, Meenan RF, Guttadauria M, Kaplan SB, Klippel J: Comparison of auranofin, gold sodium thiomalate, and placebo in the treatment of rheumatoid arthritis: A controlled clinical trial. Arth Rheum 26:1303–1315, 1983
Meenan RF, Gertman PM, Mason JH, Dunaif R: The Arthritis Impact Measurement scales: Further investigations of a health status measure. Arth Rheum 23:1048–1053, 1982
Kazis LE, Meenan RF, Anderson JJ: Pain in rheumatic diseases: Investigation of a key health status component. Arth Rheum 26:1017–1022, 1983
Meenan RF, Anderson JJ, Kazis LE, Egger MJ, Altz-Smith M, Samuelson COJ, Wilkens RF, Solsky MA, Hayes SP, Blocka KL, Weinstein A, Guttadauria M, Kaplan SB, Klippel J: Outcome assessment in clinical trials: Evidence for the sensitivity of a health status measure. Arth Rheum 27:1344–1352, 1984
Meenan RF, Gertman PM, Mason JH: Measuring health status in arthritis: The Arthritis Impact Measurement Scales. Arth Rheum 25:146–152, 1984
Potts MK, Brandt KK: Evidence of the validity for the arthritis impact measurement scales. Arth Rheum 25:146–152, 1987
Steinbrocker O, Traeger CH, Batterman RC: Therapeutic criteria in rheumatoid arthritis. JAMA 140:659–662, 1949
Bevilacqua MP, Pober JS, Majeua GR, Fiers W, Cotran RS, Gimbrone MA: Recombinant tumor necrosis factor induces procoagulant activity in human vascular endothelium: Characterization and comparison with the actions of interleukin-1. Proc Natl Acad Sci 83:4533–4537, 1986
Conkling PR, Chua CC, Nadler P, Greenberg CS, Doty E, Misukonis MA, Haney AF, Bast RC Jr, Weinberg JB: Clinical trials with human tumor necrosis factor: In vivo and in vitro effects on human mononuclear phagocyte function. Cancer Res 48:5604–5609, 1988
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Beckham, J.C., Caldwell, D.S., Peterson, B.L. et al. Disease severity in rheumatoid arthritis: Relationships of plasma tumor necrosis factor-α, soluble interleukin 2-receptor, soluble CD4/CD8 ratio, neopterin, and fibrin D-dimer to traditional severity and functional measures. J Clin Immunol 12, 353–361 (1992). https://doi.org/10.1007/BF00920793
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00920793