Romatoid artritte kan sitokin seviyelerinin aktivite kriterleri ile korelasyonunun araştırılması
Küçük Resim Yok
Tarih
2018
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
T.C. Maltepe Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Romatoid artrit patogenezinde çeşitli proinflamatuar ve antiinflamatuar sitokinler kompleks bir rol oynamaktadır ve sitokin-hedefli tedaviler olumlu sonuçlar vermektedir. Tedavide remisyonun optimum şekilde sağlanması hedeflenmektedir. Ancak aktif ve remisyonda romatoid artrit hastalarının takip ve tedaviye yanıt kriterleri subjektiftir. Biz de bu çalışmamızda ACR romatoid artrit remisyon kriterlerine göre remisyonda olan RA hastaları, aktif dönemdeki RA hastaları ve sağlıklı gönüllülerden oluşan bireylerde serumda IL-1?, IL-10, TNF-? ve TNF-R düzeylerini ölçerek remisyon ve aktivasyon kriterlerine yeni bir yaklaşım getirmeyi amaçladık. Metod: 2016-2017 yılları arasında Maltepe Üniversitesi Tıp Fakültesi Hastanesi İç Hastalıkları-Romatoloji Polikliniğine başvuran bireyler arasından ACR-romatoid artrit kriterlerine göre remisyonda olan 20 kişi, aktif dönemde olan 20 kişi ve 20 adet sağlıklı gönüllü çalışmaya dahil edildi. Bu kişiler çalışma kriterlerini sağlıyordu. Çalışma kriterleri: sigara içmiyor olmak, kortizol ve MTX dışında DMARD ve/veya antiinflamatuar ilaç kullanmıyor olmak, kemoterapi almıyor olmak, hipotiroidik olmamaktı. Çalışma grubunun 43'ü (%71.6) kadın ve 17'si (%28.4) erkekti. Poliklinikte muayeneleri yapılıp DAS-28 ve DAS-44 skorları hesaplandı (sağlıklı gönüllüler hariç) ve venöz kan örnekleri toplandı. Serumlarında IL-1?, IL-10, TNF-? ve TNF-R düzeyleri çalışıldı. Ayrıca venöz kandan sedimentasyon hızı ve CRP (C-reaktif protein) ölçümleri yapıldı. Bulunan veriler NCSS 2007 programı kullanılarak analiz edildi. Bulgular: Hastalar arasında aktif RA hastaları ile, remisyonda romatoid artrit grubu arasında TNF-R düzeyi açısından anlamlı farklılık saptandı (p<0,05). Aktif RA grubuyla remisyonda RA grubu arasında IL-10 düzeyleri açısından anlamlı farklılık saptandı (p<0,05). Değişkenler kendi aralarında kıyaslandıklarında: Aktif RA grubunda sedimentasyon hızı ve CRP arasında anlamlı ilişki saptandı (p<0,01). Aktif RA grubunda sedimentasyon hızıyla TNF-R düzeyi arasında anlamlı ilişki saptandı (p<0,05). Aktif RA grubunda CRP ile TNF-R düzeyi arasında istatistiki anlamlılık gözlendi (p<0,01). Sonuç: TNF-? seviyeleri beklenilenin aksine düşükken, CRP ile TNF-R düzeyleri arasında oldukça anlamlı bir ilişki bulunmuştur. Bu nedenle TNF-R düzeyinin ölçümünün, RA'lı hastaların takibinde önemli katkı sağlayabileceği, ayrıca aktivasyon kriterlerinde sedimentasyon hızı yerine CRP'nin kullanılmasının daha doğru bir yaklaşım olacağı sonucuna varılmıştır.
In the pathogenesis of rheumatoid arthritis many types of pro-inflammatory and anti-inflammatory cytokines play role and cytokine targeted therapies are providing satisfactory results. Optimum remission level is aimed in these treatments. But current criteria for disease activity and remission level is subjective. So, we analyzed serum levels of IL-1?, IL-10, TNF-? and TNF-R of patients in remission and active disease period according to ACR (American College of Rheumatology) remission criteria and a healthy group. In this study a new approach in evaluation of disease activity and remission was aimed. Methods: Among patients with rheumatoid arthritis applied to Maltepe University Teaching Hospital, Department of Rheumatology outpatient clinic between 2016-2017, 20 patients in remission and 20 patients with active disease according to ACR Rheumatoid arthritis criteria are included and 20 healthy volunteers are included as control group. These participants fulfilled inclusion criteria of this study. Inclusion criteria: Nonsmoker, patients not on DMARD and/or anti-inflammatory agents except cortisol and MTX (methotrexate), patient not taking chemotherapy and normal thyroid functions. Study groups were formed by 71.6% (n=43) female and 28.4% (n=17) male. Cases were evaluated in the outpatient clinic, DAS-28 & DAS-44 were calculated (except healthy volunteers) and blood samples were collected. Serum levels of IL-1?, IL-10, TNF-? and TNF-R were analyzed. Meanwhile sedimentation rate and CRP (C-reactive protein) levels were mesured in the venous blood. Data were analyzed by NCSS 2007 package program. Findings: Levels of TNF-R were significantly different between patients with active rheumatoid arthritis and patients in remission (p<0.05). Levels of IL-10 was significantly different between patients with active rheumatoid arthritis and patients in remission (p<0.05). When the variables are compared among themselves in the active RA group, sedimentation rate and CRP were significantly correlated with each other (p<0.01). Sedimentation rate was significantly correlated with TNF-R levels (p<0.05). CRP and TNF-R levels were significantly correlated (p<0.01). Results: In contrast of predictions TNF-? levels were low, CRP and TNF-receptor levels were significantly correlated with disease activity. So TNF-R levels can be used in evaluation of disease activity for following patients with RA. Furthermore as a conclusion using CRP levels instead of sedimentation rate in disease activity criteria will be a more accurate approach.
In the pathogenesis of rheumatoid arthritis many types of pro-inflammatory and anti-inflammatory cytokines play role and cytokine targeted therapies are providing satisfactory results. Optimum remission level is aimed in these treatments. But current criteria for disease activity and remission level is subjective. So, we analyzed serum levels of IL-1?, IL-10, TNF-? and TNF-R of patients in remission and active disease period according to ACR (American College of Rheumatology) remission criteria and a healthy group. In this study a new approach in evaluation of disease activity and remission was aimed. Methods: Among patients with rheumatoid arthritis applied to Maltepe University Teaching Hospital, Department of Rheumatology outpatient clinic between 2016-2017, 20 patients in remission and 20 patients with active disease according to ACR Rheumatoid arthritis criteria are included and 20 healthy volunteers are included as control group. These participants fulfilled inclusion criteria of this study. Inclusion criteria: Nonsmoker, patients not on DMARD and/or anti-inflammatory agents except cortisol and MTX (methotrexate), patient not taking chemotherapy and normal thyroid functions. Study groups were formed by 71.6% (n=43) female and 28.4% (n=17) male. Cases were evaluated in the outpatient clinic, DAS-28 & DAS-44 were calculated (except healthy volunteers) and blood samples were collected. Serum levels of IL-1?, IL-10, TNF-? and TNF-R were analyzed. Meanwhile sedimentation rate and CRP (C-reactive protein) levels were mesured in the venous blood. Data were analyzed by NCSS 2007 package program. Findings: Levels of TNF-R were significantly different between patients with active rheumatoid arthritis and patients in remission (p<0.05). Levels of IL-10 was significantly different between patients with active rheumatoid arthritis and patients in remission (p<0.05). When the variables are compared among themselves in the active RA group, sedimentation rate and CRP were significantly correlated with each other (p<0.01). Sedimentation rate was significantly correlated with TNF-R levels (p<0.05). CRP and TNF-R levels were significantly correlated (p<0.01). Results: In contrast of predictions TNF-? levels were low, CRP and TNF-receptor levels were significantly correlated with disease activity. So TNF-R levels can be used in evaluation of disease activity for following patients with RA. Furthermore as a conclusion using CRP levels instead of sedimentation rate in disease activity criteria will be a more accurate approach.
Açıklama
Anahtar Kelimeler
Romatoid artrit, Sitokin, Remisyon, Aktivasyon kriterleri, Rheumatoid arthritis, Cytokines, Remission, Activation criteria
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Ceylan, Y. (2018). Romatoid artritte kan sitokin seviyelerinin aktivite kriterleri ile korelasyonunun araştırılması. (Yayımlanmamış Tıpta Uzmanlık Tezi). Maltepe Üniversitesi, Tıp Fakültesi, İstanbul.