MUTUAL ANTAGONISM OF RHEUMATOID-ARTHRITIS AND HAY-FEVER - A ROLE FOR TYPE-1 TYPE-2 T-CELL BALANCE

Objectives-The balance between interferon gamma(IFN gamma) and interle ukin 4 (IL4) producing T cells (T1 and T2 cells) seems to be of import ance in many (auto)immune disorders. In general, T1 cell activity is i mportant in cellular immunity whereas T2 cell activity plays a part in humoral responses. T1 cell activity predominates in joints of patient s with rheumatoid arthritis (RA) whereas T2 cell activity is character istic of atopic syndromes. This study investigated whether the prevale nce of hay fever in RA is low and if severity of RA (T1 cell activity) can be influenced by the concomitant occurrence of a T2 cell mediated disease (hay fever). Methods-The prevalence of hay fever was assessed in 643 consecutive (RA and non-RA) patients seen in our outpatient cl inic and confirmed by skin test and specific IgE. Of this group the 12 RA patients with hay fever were compared with RA patients without hay fever (matched for age, sex, and disease duration). Results-The preva lence of hay fever in RA patients is lower than in non-RA patients (4% versus 8%), and yields a relative risk for RA patients to develop hay fever of 0.48. RA patients with hay fever showed a lower disease acti vity (erythrocyte sedimentation rate, C reactive proten, Thompson join t score, and radiographic joint damage (Sharp) score) than RA patients without hay fever. The clinical data were related to peripheral blood T1/T2 cell balance: a lower IFN gamma/IL4 ratio was observed for RA p atients with hay fever, indicating a comparatively increased T2 cell a ctivity in RA patients with hay fever. Conclusion-These results argue in favour of the exploration of treatments aimed at regulation of a po ssible imbalance in T1/T2 cell activity in RA.