Serum levels of vascular endothelial growth factor in juvenile rheumatoid arthritis

الملخص EN

Objective : Rheumatoid arthritis (RA) has been thought of as an angiogenesis-dependent disease where vascular proliferation may contribute to the development of destructive synovial panes.

Vascular endothelial growth factor (VEGF) is a selectively endothelial cell-specific mitogen and antigenic factor.

Little information is available regarding the possible role of VEFG in juvenile rheumatoid arthritis (JRA).

Therefore, the objective of the present study was to evaluate serum levels of VEGF in JRA to determine if it has a role in its pathogenesis.

Methodology: We studied forty children.

Thirty of them had JRA (polyarticular in 12, systemic in 10, pauciarticular in 8) and 10 were apparently healthy, age and sex matched control children.

All children were subjected to complete history taking, thorough clinical examination and the following investigations : CBC, ESR, CRP, RF, serum IL-6 and VEGF levels.

Results : The mean serum level of VEGF was significantly increased in JRA children (368.97 ± 188.37 pg / mL) as compared to normal controls (108.00 ± 16.17 pg/mL, p < 0.01).

Moreover, a significant elevation of serum VEGF was detected in each subgroup of JRA (polyarticular, systemic and pauciarticular) when compared to controls (p < 0.0001, p < 0.001 & p < 0.01 respectively).

Patients with polyarticular JRA showed statistically higher levels of VEGF than those with systemic and pauciarticular disease (540.00 ± 164.48 pg / mL in polyarticular versus 307.00 ± 90.57 pg / mL and 188.75 ± 36.82 pg / mL in systemic and pauciarticular respectively, F=36.28, p < 0.01).

JRA children had significantly higher serum IL-6 level (93.00 ± 39.0 pg / mL) as compared to controls (58.50 ± 9.01 pg / ml, p < 0.01), which was more prominent in systemic disease (F = 14.94, p < 0.01).

However, the mean serum IL-6 level showed a non-significant difference in pauciaticular JRA (72.75 ± 17.37pg / mL) as compared to controls (58.50 ± 9.01 pg / mL, p > 0.05).

Serum VEGF levels positively correlated with disease activity variables in polyarticular JRA including activity score (r = 0.684, p < 0.05), ESR (r = 0.782, p < 0.01), CRP (r = 0.698, p < 0.05) and IL-6 (r = 0.819, p < 0.01).

Conclusions: Serum VEGF levels are increased in JRA children, thus, it may play a role in its pathogenesis.

Patients with polyarticular JRA have the highest levels of serum VEGF that correlated positively with disease activity variables.

This seems to reflect the extent of joint disease severity and represents an evidence for the role of VEGF in development of arthritis in JRA.

This raises the possibility that anti-angiogenesis therapy with VEGF inhibitors may provide novel approaches to disease suppression.