Rheumatoid arthritis (RA) is an autoimmune disorder characterized by chronic joint inflammation and continuous immune cell infiltration in the synovium. These changes are linked to inflammatory cytokine release, leading to eventual destruction of cartilage and bone. During the last decade new therapeutic modalities have improved the prognosis, with the introduction of novel biological response modifiers including anti-TNFalpha CTLA4Ig and, more recently, anti-IL6. In the present study we looked at the immunological effects of these three forms of therapy. Serum, obtained from patients with RA was analyzed for TNFalpha, IL6, IL10, IFNgamma, and VEGF, and in parallel, circulating plasmacytoid and myeloid dendritic cells (DC) were enumerated before and after three infusions of the respective biological treatments. After treatment with anti-IL6, we found a significant reduction of IL6 and TNFalpha levels and the percentage of both DC subsets decreased. Although the results did not reach statistical significance for anti-TNFalpha treatment, similar trends were observed. Meanwhile, CTLA4Ig therapy led to the reduction IFNgamma levels only. None of the treatments modified significantly VEGF or IL10 levels. These findings may explain why patients with RA improve more rapidly on IL-6 therapy than with the other two modalities.

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A high frequency of growing pains was found in our study population and it shows that in a prospective evaluation of patients with signs and symptoms of unknown etiology we can find a frequency higher than that reported in literature.