IMMUNOLOGICAL STUDIES IN PATIENTS WITH RHEUMATOID-ARTHRITIS TREATED WITH METHOTREXATE OR CYCLOPHOSPHAMIDE

One-hundred-and-two-patients (pts) with rheumatoid arthritis (RA) were observed for 12 months. Forty-eight pts were treated with a weekly lo w-dose of methotrexate (MTX), 23 pts with cyclophosphamide (CTX) (eigh t pts with one single intravenous dose, and 15 pts orally with a singl e daily dose), and 31 pts with nonsteroidal antiinflammatory drugs (NS AID) only. In all individuals acute phase response, i.e., C-reactive p rotein (CRP) and alpha-1-acid glycoprotein (AGP) serum levels, and AGP microheterogeneity using affinoimmunoelectrophoresis with concanavali n A were evaluated. The phenotype of lymphocytes isolated from periphe ral blood was characterized using immunofluorescence technique. Follow ing treatment the increased level of CRP significantly decreased where as AGP serum level remained unchanged. Among the patients, microhetero geneity of AGP expressed as reactivity coefficient (RC) was lower befo re treatment when compared with 17 controls (0.95 +/- 0.23 vs. 1.35 +/ - 0.15, p<0.01). After 12 months of MTX therapy AGP-RC rose significan tly (1.19 +/- 0.13, P<0.01). No changes were observed in AGP-RC levels in CTX and NSAID treated individuals. No significant differences were observed in the percentage of CD3+, CD4+, and CD8+ cells in all the p atient groups, except in CTX intravenously treated patients. In this g roup of patients a decrease of CD44 cells was noticed (60.1 +/- 11.5% and 43.8 +/- 12.5% before and after treatment respectively - p<0.01). The percentage of CD19 positive cells decreased significantly during 1 2 months of treatment with MTX and CTX. The percentage of activated T cells (CD25 + cells and HLA-DR+ cells) remained unchanged in MTX treat ed patients and was reduced in both CTX groups. We did not observe any correlation between the changes in lymphocyte phenotype and acute pha se protein levels.