Unusual CD4+ T lymphocyte subset is implicated in the pathogenesis of early A therosclerosis in patients with rheumatoid arthritis

الملخص EN

Background : Rheumatoid arthritis (RA) is associated with accelerated atherosclerosis which is not fully explained by traditional risk factors.

Such excess risk appears to be driven by systemic inflammation.

The aim of this study was to evaluate the relationship between early atherosclerotic changes and CD4 + CD28 - T-cells, a subset of T lymphocytes with high proinflammatory and tissue-damaging potential, in patients with RA.

Patients and Methods : The study was conducted on 39 female patients with RA free of overt cardiovascular disease or risk factors for it and 15 age matched control subjects.

Atherosclerotic changes were assessed through measurement of carotid intima-media thickness (IMT) and brachial artery post-obstructive flow-mediated endothelium-dependent dilatation (FMEDD) and CD4 + CD28-T-cells were assessed by flow cytometry.

Results : Despite similar levels of traditional atherosclerotic risk factors, patients with RA had higher carotid IMT and lower FMEDD of brachial artery compared to controls (0.84 ± 0.24 mm vs 0.64 ± 0.12 mm, p < 0.01 and 3.27 ± 1.49 % vs 5.87 ± 1.68 %, p < 0.001 ; respectively).

In addition, patients with expansion of circulating CD4 + CD28-T-cells had more marked increase of carotid IMT and decrease of brachial artery FMEDD compared to those without expansion (1.00 ± 0.23 mm vs 0.76 ± 0.21 mm, p < 0.01 and 2.25 ± 1.06 % vs 3.67 ± 1.47 %, p < 0.01 ; respectively).

Conclusions : From this study, it can be concluded that CD4 + CD28 - cells contribute to the development of premature atherosclerosis in patients with RA.

Further studies are recommended to evaluate the benefit of CD4 + CD28 - T-cell modulation on the future development of atherosclerosis in these patients.