Skip to main content

Interleukin-17 level in rheumatoid arthritis patients and its relation to disease activity: a clinical and ultrasound study

Abstract

Objective

The aim of this study was to measure the level of interleukin-17A (IL-17A) in the serum and synovial fluid of patients with rheumatoid arthritis (RA) and its relation to disease activity.

Patients and methods

A total of 100 patients suffering from RA were chosen from the outpatient clinic, Department of Physical Medicine and Rehabilitation, Menoufia University Hospital. The patient group was divided into three subgroups — mild, moderate, and severe — according to the disease activity score. All patients were subjected to clinical, laboratory, and ultrasound evaluation and to measurement of IL-17A in the serum and synovial fluid by means of the enzyme-linked immunosorbent assay technique. Fifty healthy individuals were evaluated for IL-17A level in the blood, and served as the control group.

Results

The present study revealed an increase in serum (P = 3.1) and synovial fluid (P = 5.2) IL-17A levels in RA patients with increased disease activity. The ultrasound study showed an increase in serum IL-17A levels with increased erosion of the knee (P= 5.99) and wrist (P= 5.03). There was an increase in serum IL-17A with increased effusion of the knee (P = 22.6) and wrist (P = 33.3). There was an increase in serum IL-17A with increased synovial hypertrophy of the knee (P = 6.39), wrist (P = 12.23), and second metacarpophalangeal (MCP) (P = 53.34). Finally, there was an increase in the blood IL-17A level, dryness of the eye (P = 3.8), dryness of the mouth (P = 3.2), and number of subcutaneous nodules (P = 2.5).

Conclusion

In our study; the mean serum and synovial IL-17A levels were found in high titers in patients with disease activity, and with extra-articular manifestations like dry eyes, dry mouth, and subcutaneous nodules. Also erosions, synovial hypertrophy, and effusions were found with significantly high titers of IL-17A, denoting its usefulness as a measurement tool for high disease activity and destruction. Also targeting IL-17A may be useful as a treatment option for aggressive disease and for rheumatoid patients with poor prognosis.

References

  1. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Birnbaum NS, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010; 62:2569–2581.

    Article  Google Scholar 

  2. Roşu A, Mărgăritescu C, Stepan A, Muşetescu A, Ene M. IL-17 patterns in synovium, serum and synovial fluid from treatment-naïve, early rheumatoid arthritis patients. Rom J Morphol Embryol 2012; 53:73–80.

    PubMed  Google Scholar 

  3. Benedetti G, Miossec P. Interleukin 17 contributes to the chronicity of inflammatory diseases such as rheumatoid arthritis. Eur J Immunol 2014; 44:339–347.

    Article  CAS  Google Scholar 

  4. Fransen J, van Riel PL. The Disease Activity Score and the EULAR response criteria. Clin Exp Rheumatol 2005; 23(Suppl 39):93–99.

    Google Scholar 

  5. P Courtney. Joint aspiration and injection and synovial fluid analysis. Best Pract Res Clin Rheumatol 2009; 23:161–192.

    Article  Google Scholar 

  6. Inas A, Ahmed G. Serum level of il17, il 22 and IFN in psoriasis. Egypt Dermatol Online J 2009; 5:1–4.

    Google Scholar 

  7. European Society of Musculoskeletal Radiology (ESSR). Musculoskeletal ultrasound: technical guidelines edited by the Ultrasound Subcommittee of the Insights Imaging (2010). 1:99–141

    Google Scholar 

  8. Morton RF, Hebel JR, McCarter RJ. Medical statistics. In study guide to epidemiology and biostatistics 5th ed. Gaithersburg, Maryland: Aspen Publication; 2001. 5:71–74.

  9. Metawi SA, Abbas D, Kamal MM, Ibrahim MK. Serum and synovial fluid levels of interleukin-17 in correlation with disease activity in patients with RA. Clin Rheumatol 2011; 30:1201–1207.

    Article  Google Scholar 

  10. Sarkar S, Justa S, Brucks M, Endres J, Fox DA, Zhou X, et al. Interleukin (IL)-17A, F and AF in inflammation: a study in collagen-induced arthritis and rheumatoid arthritis. Clin Exp Immunol 2014; 177:652–661.

    Article  CAS  Google Scholar 

  11. Brentano F, Ospelt C, Stanczyk J, Gay RE, Gay S, Kyburz D. Abundant expression of the interleukin (IL)23 subunit p19, but low levels of bioactive IL23 in the rheumatoid synovium: differential expression and Toll-like receptor-(TLR) dependent regulation of the IL23 subunits, p19 and p40, in rheumatoid arthritis. Ann Rheum Dis 2009; 68:143–150.

    Article  CAS  Google Scholar 

  12. Kim J, Kang S, Kim J, Kwon G, Koo S. Elevated levels of T helper 17 cells are associated with disease activity in patients with rheumatoid arthritis. Ann Lab Med 2013; 33:52–59.

    Article  Google Scholar 

  13. Pavlovic V, Dimic A, Milenkovic S, Krtinic D. Serum levels of IL-17, IL-4, and INFγ in Serbian patients with early rheumatoid arthritis. J Res Med Sci 2014; 19:18–22.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Guggino G, Giardina A, Ferrante A, Giardina G, Schinocca C, Sireci G, et al. The in vitro addition of methotrexate and/or methylprednisolone determines peripheral reduction in Th17 and expansion of conventional Treg and of IL-10 producing Th17 lymphocytes in patients with early rheumatoid arthritis. Rheumatol Int 2015; 35:171-175.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alaa Abdel-Aziz Labeeb PhD.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Elhewala, A.E.I., Soliman, S.G., Labeeb, A.AA. et al. Interleukin-17 level in rheumatoid arthritis patients and its relation to disease activity: a clinical and ultrasound study. Egypt Rheumatol Rehabil 42, 183–187 (2015). https://doi.org/10.4103/1110-161X.168164

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1110-161X.168164

Keywords

  • disease activity score
  • interleukin-17
  • rheumatoid arthritis
  • ultrasonography