CONTRASTING CYTOKINE PROFILES IN THE SYNOVIUM OF DIFFERENT FORMS OF JUVENILE RHEUMATOID-ARTHRITIS AND JUVENILE SPONDYLOARTHROPATHY - PROMINENCE OF INTERLEUKIN-4 IN RESTRICTED DISEASE

Objective, To determine the pattern of expression of Type 1 and Type 2 cytokines in synovial tissues and fluids (SF) of patients with differ ent forms of juvenile rheumatoid arthritis (JRA) and juvenile spondylo arthropathy (JSpA), and to contrast these with findings in adult patie nts with RE. Methods. Sixty-three SF mononuclear cell preparations and synovial tissue samples from 50 patients with JRA or JSpA and 7 synov ial tissues from patients with adult onset RA were analyzed by reverse transcription polymerase chain reaction for the presence or absence o f interleukin 2 (IL-2), tumor necrosis factor-beta (TNF-beta), interfe ron-gamma (lFN-gamma), and IL-10 and IL-4 mRNA. Results, IL-4 mRNA was identified significantly more often in the synovial compartrnent of p atients with pauciarticular onset disease (JRA or JSpA) compared with polyarticular onset JRA (58 vs 14%; p<0.01) or RA (29%). Similarly, IL -4 mRNA was detected mon often in those with a persistently pauciartic ular disease course compared to those with a polyarticular course (68 vs 30%; p<0.01). Furthermore, the combination of IL-4 and IL-10 mRNA w as found more frequently in nonerosive compared with erosive disease ( 38 vs 15%; p<0.05). IL-2 and TNF-D mRNA were found in all groups. IFN- gamma mRNA was detected in 33% of those with systemic onset JRA compar ed with 85% of other types of JRA (p<0.01). Conclusion. This study pro vides further evidence of immunopathological differences between chron ic forms of arthritis with childhood onset, and highlights similaritie s with and differences from adult RA. Our findings suggest that IL-4, possibly in combination with IL-10, has an antiinflammatory or disease restricting role.