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, increase of interleukin 10, and predicted by the initial
concentration of interleukin 4
a Department of
Medicine, Rheumatology, University Hospital Benjamin Franklin,
Hindenburgdamm 30, 12200 Berlin, Germany, b Deutsches Rheuma- Forschungszentrum, Berlin,
Germany
Correspondence to: Professor Sieper
Accepted for publication 26 November 1999
OBJECTIVE
This study
was performed to assess whether there is any change in the T cell
cytokine pattern in early rheumatoid arthritis (RA) patients treated
with methotrexate (MTX) and whether the lymphocytic cytokine pattern
correlates with disease activity.
METHODSEight patients
with RA (disease duration < six months) were studied serially before,
after three, and after six to nine months of treatment with MTX for the
cytokines tumour necrosis factor 
(TNF), interferon 
(IFN),
interleukin 4 (IL4) and interleukin 10 (IL10) by intracellular staining
of T cells derived from peripheral blood. Response to treatment was
assessed by the modified disease activitiy score.
RESULTSThe clincial
response was accompanied by a significant decrease of TNF positive
CD4+ T cells from a median of 8.53% (interquartile range
5.83-10.91%) before treatment to 6.17% (2.15-6.81%) after six to
nine months of treatment (p=0.021). Inversely, IL10 positive T cells
increased from a median of 0.65% (interquartile range 0.6-0.93%) to
a median of 1.3% (1.22%-1.58%) after six to nine months of treatment
(p=0.009). No significant change in the percentage of INF positive T
cells and a small decrease of IL4 positive T cells during treatment were observed. The percentage of IL4 positive CD4+ T cells
before treatment correlated with disease activity after six to nine
months (r= 
0.7066; p=0.05).
CONCLUSIONSDuring
treatment of RA with MTX the percentage of TNF producing T cells
decreases whereas that of IL10 producing T cells increases. This may
affect macrophage activation and, therefore, may represent a regulatory
mechanism relevant to disease remission. Furthermore, the percentage of
IL4 positive CD4+ T cells at disease onset may be a useful
prognostic marker.
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