Intracytoplasmic Expression of IL-6 and IL-17A in Circulating CD4+ T Cells Are Strongly Associated with and Predict Disease Activity in Rheumatoid Arthritis: A Case-Control Study in Ghana

Abstract EN

Background.

T cell cytokines play important roles in the development and progression of rheumatoid arthritis (RA).

Loss of Th1/Th2 and Th17/Treg balance has been reported in several inflammatory autoimmune diseases.

However, their role in RA within hitherto rare Ghanaian context has not been explored.

Here, we evaluated the intracytoplasmic CD4+ T cell cytokine patterns in rheumatoid arthritis patients in Ghana and determined their relationship with disease activity.

Methods.

This case-control study included 48 newly diagnosed RA patients and 30 apparent healthy controls from two major hospitals in Ghana.

Validated structured questionnaires were administered to obtain demographic data; blood samples were collected and processed for flow cytometric analysis.

Results.

IFN-γ, TNF-α, IL-4, IL-6, IL-10, IL-17A, IL-6/IL-4, and IL-17/IL-10 expressions were significantly higher in RA cases compared to the healthy controls.

The expression of IL-6 (0.00 (0.00-0.98) vs.

0.82 (0.34-1.10) vs.

1.56 (1.39-1.68), p<0.0001), IL-17A (0.00 (0.00-0.02) vs.

0.19 (0.09-0.30) vs.

0.99 (0.64-1.25), p<0.0001), and IL-17A/IL-10 (0.00 (0.00-0.39) vs.

0.15 (0.09-0.26) vs.

0.88 (0.41-1.47), p<0.0001) increased significantly from the healthy controls through RA patients with low DAS scores to RA patients with moderate DAS scores.

IL-6 (β=0.681, r2=0.527, p<0.0001), IL-17A (β=0.770, r2=0.593, p<0.0001), and IL-17A/IL-10 (β=0.677, r2=0.452, p<0.0001) expressions were significantly directly associated with DAS28 scores.

IL-6 (cutoff=1.32, sensitivity=100.0%, specificity=100.0%, accuracy=100.0%, and AUC=1.000) and IL-17A (cutoff=0.58, sensitivity=100.0%, specificity=100.0%, accuracy=100.0%, and AUC=1.000) presented with the best discriminatory power in predicting moderate DAS scores from low DAS scores.

Conclusion.

Th1- and Th17-related cytokines predominate in the pathophysiology of RA, with IL-6 and IL-17 being principally and differentially expressed based on the severity of the disease.

IL-6 and IL-17A could serve as useful prognostic and disease-monitoring markers in RA in the African context.