STEROID PULSE THERAPY FOR RHEUMATOID-ARTHRITIS - EFFECT ON LYMPHOCYTESUBSETS AND MONONUCLEAR CELL-ADHESION

Eighteen patients with clinically active rheumatoid arthritis, satisfy ing the ARA criteria, were admitted to hospital for i.v. methylprednis olone pulse therapy. Studies of circulating lymphocyte subsets 1 h bef ore and 24 h after pulsing were carried out together with studies on t heir adhesion to endothelium-containing lamina propria of porcine gut at various time points. Additionally, circulating VCAM-1 was estimated pre- and post-pulse by ELISA. We observed a marked fall (59%) in mono nuclear cell adhesion 24 h post-pulse therapy (P < 0.001). Accompanyin g this was a significant, though slight, fall in circulating mononucle ar cells (P < 0.01), mainly involving T cells. However, the degree of reduction in cell adhesion did not appear to reflect change in any par ticular circulating subset, but was more likely due to changes in adhe sion molecule expression of several subsets. No significant change in circulating VCAM-1 was observed. It would appear, therefore, that the early beneficial effect of steroid pulsing in rheumatoid arthritis coi ncides with a demonstrable reduction in cell adhesion to gut. This may have implications for the pathogenesis of this disease.