Impaired cutaneous cell-mediated immunity in newly diagnosed rheumatoid arthritis

Background. Rheumatoid arthritis is characterized by an impaired immune res ponse and a defective cutaneous cell-mediated immunity has been reported. T his study was realised in order to determine the characteristics of cutaneo us cell-mediated immunity in patients affected by recent-onset and untreate d rheumatoid arthritis. Methods. Forty-enght patients affected by newly diagnosed rheumatoid arthri tis were studied by skin testing with seven common recall antigens, The ski n tests were performed before the administration of disease modifying anti- rheumatic drugs (methotrexate, cyclosporine-A, hydroxychloroquine) and were repeated after four months of therapy. Results. 43.75% of the RA patients (21 out of 48) were defined as anergic c ompared with 2% of the normal control subjects and the rate of depression o f cutaneous cell-mediated immunity was not related either with the markers of disease activity or with the clinical assessment. The impaired cutaneous cell-mediated immunity shows a slight improvement after methotrexate thera py, while cyclosporine-A and hydroxychloroquine were not able to achieve th e same result. Conclusions, Rheumatoid arthritis shows a defective cutaneous cell-mediated immunity when the patients are studied in the early phase of the disease a nd before a second-line of therapy with disease modifying anti-rheumatic dr ugs. The anergy does not correlate either with the disease activity or with the short-term response to treatment, The prognostic significance of these data remains uncertain.