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Oligoartiküler juvenil idiopatik artrit hastalarının aktif ve inaktif dönemdeki sitokin düzeylerinin değerlendirilmesi

Yıl 2019, , 252 - 257, 30.07.2019
https://doi.org/10.12956/tchd.546933

Öz

Giriş



Juvenil idiopatik artrit (JİA) çocukluk çağının en sık görülen
romatolojik hastalığıdır. Kısa ve uzun dönemde ciddi morbiditelere yol
açabilir. JİA’da hastalık aktivasyonu klinik değerlendirme ve inflamasyonun
bilinen belirteçleri ile gösterilebilir. Ancak günümüz pratiğinde bu iki
parametre her zaman birbiri ile uyum içerisinde olmamakta, bu durumda da
özellikle tedavinin planlanmasında ve izleminde zorluklara yol açmaktadır. Bu
çalışma ile amacımız interlökin-1β (İL-1β), interlökin-6 (İL-6), tümör
nekrozitan faktör alfa (TNF-α)’nın oligoartiküler JİA’da hastalık aktivitesini göstermede
kullanılabilirliğini araştırmaktır.



Gereç ve
yöntemler



Yeni tanı almış 13 oligoartiküler JİA hastası ve 8 sağlıklı
kontrol çalışmaya dâhil edildi. Hastaların başvurularında ve inaktif
dönemlerinde İL-1β, TNF-α ve İL-6 düzeyleri bakıldı. Hastaların aktivite ve
yaşam kalitesi ölçümleri için JADAS-27 (Juvenile Arthritis Disease Activity
Score) ve JAQQ (Juvenile Arthritis Quality of Life Questionnaire) kullanıldı.



Bulgular



Hastaların aktif dönemlerinde bakılan İL-6, İL-1β ve TNF-α
düzeyleri ile inaktif dönem ve kontrol grubu arasında anlamlı farklılık
saptanmadı. Hastaların ilk başvurularındaki JADAS-27 skorları ile inaktif
dönemdeki JADAS-27 skorları karşılaştırıldığında anlamlı olarak inakif dönemde
skorda azalma olduğu saptandı (p=0,02). Hastaların JAQQ puanları
karşılaştırıldığında ise gruplar arasında anlamlı farklılık saptanmadı
(p=0,382).  JADAS-27 puanları >10 ve ≤
10 olanların sitokin düzeyleri karşılaştırıldığında, gruplar arasında düşük
puana sahip hastalarda anlamlı olarak düşük İL-1β düzeyi saptandı. İL-6 ve
TNF-α düzeyleri için ise fark anlamlı bulunmadı.



Tartışma



JİA hastalarında aktivasyonun ve remisyonun değerlendirilmesi için
çeşitli laboratuvar değerleri ve aktivite skorları kullanılmaktadır.
Sonuçlarımız
ve literatür ışığında bakıldığında oligoartiküler JİA hastalarında sitokin
düzeylerinin hastalık izlem ve aktivitesininin değerlendirilmesinde
kullanılabilirliği kısıtlıdır.

Kaynakça

  • 1) Petty RE, Laxer RM, Wedderburn LR (2016) Juvenile idiopathic arthritis. In: Petty RE, Laxer RM, Lindsley CB et al (eds) Textbook of pediatric rheumatology, 7th edn. Elsevier, Philadelphia, pp 188– 204.
  • 2) Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet 2007;369:767-78.
  • 3) Spîrchez M, Samaşca G, Iancu M, Bolba C, Miu N. Relation of interleukin-6, TNF-alpha and interleukin-1alpha with disease activity and severity in juvenile idiopathic arthritis patients. Clin Lab. 2012;58:253-60.
  • 4) Rooney M, David J, Symons J, Di Giovine F, Varsani H, Woo P. Inflammatory cytokine responses in juvenile chronic arthritis. Br J Rheumatol. 1995;34:454-60.
  • 5) Mangge H, Kenzian H, Gallistl S, Neuwirth G, Liebmann P, Kaulfersch W, et al. Serum cytokines in juvenile rheumatoid arthritis. Correlation with conventional inflammation parameters and clinical subtypes. Arthritis Rheum. 1995;38(2):211-20.
  • 6) Ou LS, See LC, Wu CJ, Kao CC, Lin YL, Huang JL. Association between serum inflammatory cytokines and disease activity in juvenile idiopathic arthritis. Clin Rheumatol. 2002;21:52-6.
  • 7) Kaminiarczyk-Pyzalka D, Adamczak K, Mikos H, Klimecka I, Moczko J, Niedziela M. Serum TNF-α levels and indicators of disease activity in children with oligoarticular juvenile idiopathic arthritis (oJIA) in the first year of the disease. Clin Lab. 2014;60:799-807.
  • 8) Yilmaz M, Kendirli SG, Altintas D, Bingöl G, Antmen B. Cytokine levels in serum of patients with juvenile rheumatoid arthritis. Clin Rheumatol. 2001;20:30-5.
  • 9) Macaubas C, Nguyen K, Milojevic D, Park JL, Mellins ED. Oligoarticular and polyarticular JIA: epidemiology and pathogenesis. Nat Rev Rheumatol. 2009;5:616-26.
  • 10) Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31:390-2.
  • 11) Consolaro A, Giancane G, Schiappapietra B, Davì S, Calandra S, Lanni S, et al. Clinical outcome measures in juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2016;14:23.
  • 12) Amine B, Rostom S, Benbouazza K, Abouqal R, Hajjaj-Hassouni N. Health Related quality of life survey about children and adolescents with juvenile idiopathic arthritis. Rheumatol Int. 2009;29:275-9.
  • 13) Prieur AM, Kaufmann MT, Griscelli C, Dayer JM. Specific interleukin-1 inhibitor in serum and urine of children with systemic juvenile chronic arthritis. Lancet. 1987;2:1240-2.
  • 14) Alarcon-Riquelme ME, Vazquez-Mellado J, Gomez-Cordillo M, Alcocer-Varela J, Burgos-Vargas R, Alarco ́n-Segovia D. Immuoregulatory defects in juvenile rheumatoid arthritis: Comparison between patients with systemic or polyarticular forms. J Rheumatol 1988;15:1547–50.
  • 15) Sandborg CI, Berman MA, Andrews BS, Mirick GR, Friou GJ. Increased production of an interleukin-1 inhibitor with fibroblast stimulation activity by mononuclear cells from patients with scleroderma. Clin Exp Immunol 1986;66:321–9.
  • 16) Funk RS, Chan MA, Becker ML. Cytokine Biomarkers of Disease Activity and Therapeutic Response after Initiating Methotrexate Therapy in Patients withJuvenile Idiopathic Arthritis. Pharmacotherapy. 2017;37:700-711.
  • 17) Madson KL, Moore TL, Lawrence JM, 3rd, Osborn TG. Cytokine levels in serum and synovial fluid of patients with juvenile rheumatoid arthritis. The Journal of rheumatology 1994;12:2359-63.
  • 18) De Benedetti F, Robbioni P, Massa M, Viola S, Albani S, Martini A. Serum interleukin-6 levels and joint involvement in polyarticular and pauciarticular juvenile chronic arthritis. Clin Exp Rheumatol 1992;5:493-8.
  • 19) Lepore L, Pennesi M, Saletta S, Perticarari S, Presani G, Prodan M. Study of IL-2, IL-6, TNF alpha, IFN gamma and beta in the serum and synovial fluid of patients with juvenile chronic arthritis. Clin Exp Rheumatol 1994;5:561-5.
  • 20) Gattorno M, Picco P, Buoncompagni A, Stalla F, Facchetti P, Sormani MP, et al. Serum p55 and p75 tumor necrosis factor receptors as markers of disease activity in juvenile chronic arthritis. Ann Rheum Dis 1996;55:243–7.
  • 21) El Gazzar II, Fathy HM, Gheita TA, Nour El-Din AM, Rasheed EA, Bassyouni RH, et al. Tumor necrosis factor-α -308 A/G gene polymorphism in children with juvenile idiopathic arthritis: relation to disease activity, damage, and functional status. Clin Rheumatol. 2017;36:1757-1763.
  • 22) Woo P. Cytokines and juvenile idiopathic arthritis. Curr Rheumatol Rep. 2002;4:452-7.

Evaluation of cytokine levels of oligoarticular juvenile idiopathic artrithis patients in active and inactive period

Yıl 2019, , 252 - 257, 30.07.2019
https://doi.org/10.12956/tchd.546933

Öz

Objective

Juvenile idiopathic arthritis (JIA) is the most common
rheumatologic disorder in childhood. It may cause
short and long-term morbidities. Disease activity assessment in JIA patients is
based on clinical examination and conventional parameters of inflammation. However,
those parameters are not always in concordance and there could be difficulties
in planning of therapy and management. The aim of this study is to evaluate the
role of interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor
alfa (TNF-α) in determining disease activity of JIA patients. 

Materials
and methods

Thirteen new diagnosed oligoarticular JIA patients and
eight healthy controls were enrolled in the study. We investigated serum levels
of IL-1β, TNF-α and IL-6 during both active
and inactive phases of the disease. To evaluate the disease activity and
quality of life we used JADAS-27 (Juvenile Arthritis
Disease Activity Score) and JAQQ (Juvenile
Arthritis Quality of Life Questionnaire).

Results

There were no statistically significant
differences regarding IL-6, IL-1β and TNF-α between the active phase, inactive
phase and control group. Comparing JADAS-27 scores, there was a statistically
significant decrease in inactive period compared with the inactive period (p=0.02).
However, no significant difference was obtained about the JAQQ scores between
active and inactive stage (p=0.382).  Levels
of IL-1β were significantly decreased in patients with low disease activity (JADAS-27
score ≤ 10) compared with those of severe and moderate disease activity (JADAS-27
score >10). On the other hand, no significant differences were obtained for
IL-6 and TNF-α.

Conclusion















There are few methods to evaluate the
activation and remission periods of JİA. According to our results and the
literature assessment of cytokine levels has limited value in diagnosis,
monitoring and evaluating the severity of the oligoarticular JIA patients.  

Kaynakça

  • 1) Petty RE, Laxer RM, Wedderburn LR (2016) Juvenile idiopathic arthritis. In: Petty RE, Laxer RM, Lindsley CB et al (eds) Textbook of pediatric rheumatology, 7th edn. Elsevier, Philadelphia, pp 188– 204.
  • 2) Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet 2007;369:767-78.
  • 3) Spîrchez M, Samaşca G, Iancu M, Bolba C, Miu N. Relation of interleukin-6, TNF-alpha and interleukin-1alpha with disease activity and severity in juvenile idiopathic arthritis patients. Clin Lab. 2012;58:253-60.
  • 4) Rooney M, David J, Symons J, Di Giovine F, Varsani H, Woo P. Inflammatory cytokine responses in juvenile chronic arthritis. Br J Rheumatol. 1995;34:454-60.
  • 5) Mangge H, Kenzian H, Gallistl S, Neuwirth G, Liebmann P, Kaulfersch W, et al. Serum cytokines in juvenile rheumatoid arthritis. Correlation with conventional inflammation parameters and clinical subtypes. Arthritis Rheum. 1995;38(2):211-20.
  • 6) Ou LS, See LC, Wu CJ, Kao CC, Lin YL, Huang JL. Association between serum inflammatory cytokines and disease activity in juvenile idiopathic arthritis. Clin Rheumatol. 2002;21:52-6.
  • 7) Kaminiarczyk-Pyzalka D, Adamczak K, Mikos H, Klimecka I, Moczko J, Niedziela M. Serum TNF-α levels and indicators of disease activity in children with oligoarticular juvenile idiopathic arthritis (oJIA) in the first year of the disease. Clin Lab. 2014;60:799-807.
  • 8) Yilmaz M, Kendirli SG, Altintas D, Bingöl G, Antmen B. Cytokine levels in serum of patients with juvenile rheumatoid arthritis. Clin Rheumatol. 2001;20:30-5.
  • 9) Macaubas C, Nguyen K, Milojevic D, Park JL, Mellins ED. Oligoarticular and polyarticular JIA: epidemiology and pathogenesis. Nat Rev Rheumatol. 2009;5:616-26.
  • 10) Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31:390-2.
  • 11) Consolaro A, Giancane G, Schiappapietra B, Davì S, Calandra S, Lanni S, et al. Clinical outcome measures in juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2016;14:23.
  • 12) Amine B, Rostom S, Benbouazza K, Abouqal R, Hajjaj-Hassouni N. Health Related quality of life survey about children and adolescents with juvenile idiopathic arthritis. Rheumatol Int. 2009;29:275-9.
  • 13) Prieur AM, Kaufmann MT, Griscelli C, Dayer JM. Specific interleukin-1 inhibitor in serum and urine of children with systemic juvenile chronic arthritis. Lancet. 1987;2:1240-2.
  • 14) Alarcon-Riquelme ME, Vazquez-Mellado J, Gomez-Cordillo M, Alcocer-Varela J, Burgos-Vargas R, Alarco ́n-Segovia D. Immuoregulatory defects in juvenile rheumatoid arthritis: Comparison between patients with systemic or polyarticular forms. J Rheumatol 1988;15:1547–50.
  • 15) Sandborg CI, Berman MA, Andrews BS, Mirick GR, Friou GJ. Increased production of an interleukin-1 inhibitor with fibroblast stimulation activity by mononuclear cells from patients with scleroderma. Clin Exp Immunol 1986;66:321–9.
  • 16) Funk RS, Chan MA, Becker ML. Cytokine Biomarkers of Disease Activity and Therapeutic Response after Initiating Methotrexate Therapy in Patients withJuvenile Idiopathic Arthritis. Pharmacotherapy. 2017;37:700-711.
  • 17) Madson KL, Moore TL, Lawrence JM, 3rd, Osborn TG. Cytokine levels in serum and synovial fluid of patients with juvenile rheumatoid arthritis. The Journal of rheumatology 1994;12:2359-63.
  • 18) De Benedetti F, Robbioni P, Massa M, Viola S, Albani S, Martini A. Serum interleukin-6 levels and joint involvement in polyarticular and pauciarticular juvenile chronic arthritis. Clin Exp Rheumatol 1992;5:493-8.
  • 19) Lepore L, Pennesi M, Saletta S, Perticarari S, Presani G, Prodan M. Study of IL-2, IL-6, TNF alpha, IFN gamma and beta in the serum and synovial fluid of patients with juvenile chronic arthritis. Clin Exp Rheumatol 1994;5:561-5.
  • 20) Gattorno M, Picco P, Buoncompagni A, Stalla F, Facchetti P, Sormani MP, et al. Serum p55 and p75 tumor necrosis factor receptors as markers of disease activity in juvenile chronic arthritis. Ann Rheum Dis 1996;55:243–7.
  • 21) El Gazzar II, Fathy HM, Gheita TA, Nour El-Din AM, Rasheed EA, Bassyouni RH, et al. Tumor necrosis factor-α -308 A/G gene polymorphism in children with juvenile idiopathic arthritis: relation to disease activity, damage, and functional status. Clin Rheumatol. 2017;36:1757-1763.
  • 22) Woo P. Cytokines and juvenile idiopathic arthritis. Curr Rheumatol Rep. 2002;4:452-7.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular İç Hastalıkları
Bölüm ORIGINAL ARTICLES
Yazarlar

Özge Başaran 0000-0002-8534-0930

Fatma Aydın 0000-0003-0306-7473

Nilgün Çakar Bu kişi benim 0000-0002-1853-0101

Nermin Uncu 0000-0001-9170-3956

Ajda Bal 0000-0002-3910-2851

Murat Kızılgün Bu kişi benim 0000-0001-5551-4058

Banu Çelikel Acar 0000-0002-1808-3655

Yayımlanma Tarihi 30 Temmuz 2019
Gönderilme Tarihi 29 Mart 2019
Yayımlandığı Sayı Yıl 2019

Kaynak Göster

Vancouver Başaran Ö, Aydın F, Çakar N, Uncu N, Bal A, Kızılgün M, Çelikel Acar B. Oligoartiküler juvenil idiopatik artrit hastalarının aktif ve inaktif dönemdeki sitokin düzeylerinin değerlendirilmesi. Türkiye Çocuk Hast Derg. 2019;13(4):252-7.

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