Background:Secondary Sjogren’s Syndrome (sSS) is diagnosed when symptoms of SS coexist with other systemic connective tissue disease, often secondary to rheumatoid arthritis(RA).The occurrence of SS secondary with RA will worsen the course of disease and increase the high incidence and mortality of RA. At present, the immune characteristics of peripheral blood of sSS with RA are not clear.Objectives:To observe the difference of immune Immune characteristics in peripheral blood between sSS secondary to RA, primary Sjogren’s syndrome(pSS) and RA patients.Methods:20 sSS with RA patients, 20 pSS paients and 20 RA pateints hospitalized in ShanXi medical university the second Hospital were enrolled. The percentage and absolute numbers of lymphocyte phenotypes and CD4+ T subsets in peripheral blood were examined by flow cytometry.Results:As for the percentage and absolute number of total T, B, NK, CD4+T,CD8+ T and the ratio of CD4 + T to CD8+ T cells, there was no significant difference between the sSS with RA, RA, and SS group. There was also no statistical difference in the percentage of CD4+T subsets(Th1,Th2,Th17 and Treg) between the three groups. But the ratio of Th17 and Treg in sSS with RA group was increased than pSS group.About comparison of absolute number of CD4+T subsets, there was no statistical difference among the three groups except that the Th1 cells in RA group was significantly higher than SS group.Conclusion:Elevated Th17/Treg may be an immunological feature that differentiates sSS with RA patients from pSS patients. In addition, in general, peripheral blood of patients with RA and SS have similar immune characteristics.References:[1]Wei W,Ahmad S S, Chi S. From Molecular Mechanism to the Etiology of Sjogren Syndrome.Curr Pharm Des. 2018;24(35):4177-4185.[2]Hajiabbasi A, Masooleh I S,Alizadeh Y, Secondary Sjogren’s Syndrome in 83 Patients With Rheumatoid Arthritis.Acta Med Iran.2016;54(7):448-53.Figure 1.The comparsion about the lymphocyte phenotypes and CD4+ T subsets in peripheral blood of sSS with RA(n=20), pSS(n=20) and RA patients(n=20).(*p<0.05,**p<0.001,*p<0.0001)Disclosure of Interests:None declared

Background:Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune disease with chronic systemic inflammation and fibrosis. The main feature of the disease was diffuse swell of the affected organs, and the serum IgG4 level was increased. Histopathology of the lesions showed infiltration of IgG4+ plasma cells. However, the pathogenesis of IgG4-RD is still unclear[1].Objectives:To explore the clinical characteristic of lymphocyte subsets of IgG4-related disease patients, and make comparisons with healthy controls.Methods:A total of 31 patients with IgG4-RD who were admitted to the Rheumatic Immunology Department of the Second Hospital of Shanxi Medical University from January 2016 to June 2020 were included. We collected their Clinical and laboratory data, and selected 30 age and sex matched healthy people as the control group. Flow cytometry was used to detect the percentage and absolute number of lymphocyte subsets (T, B, NK, CD4+T, CD8+T) and CD4+T subsets (Th1, Th2, Th17, CD4+CD25+Foxp3+Treg) in peripheral blood of IgG4-RD patients and healthy controls.Results:(1)The percentage of CD4+T cells in peripheral blood of IgG4-RD patients was higher than that of healthy controls [45.00(33.97-51.48) vs. 39.36(33.78-43.30), P<0.05]. (2)The percentage and absolute number of Th17 cells was increased in IgG4-RD patients [1.13(0.70-1.55) vs. 0.77(0.43-1.07), P<0.05; 7.90(5.20-12.23) vs. 5.60(3.12-8.47), P<0.05], while the percentage of Treg cells was decreased [3.37(2.82-5.65) vs. 4.96(4.18-6.34), P<0.01]. But Treg cells number showed no difference between the two groups. (3) Th17/Treg ratio was significantly increased in IgG4-RD patients [0.29(0.16-0.46) vs. 0.15(0.08-0.23), P<0.01], and it was positively correlated with IgG4-RD response index score(r=0.491, P<0.01). (Table 1).Table 1.Comparation of absolute number and percentage of peripheral blood lymphocyte subsets between IgG4-RD patients(n=31) and healthy controls (n=30).cell subsetsIgG4-RD (n=31)HC(n=30)P valueB150.59(120.14-212.38)203.27(152.90-244.27)0.089B%8.74(6.46-11.45)10.03(8.26-13.21)0.059NK261.98(178.82-303.08)290.83(179.93-451.45)0.175NK%13.14(9.92-18.10)16.50(11.24-21.75)0.105CD3+T1357.44(992.00-1844.82)1305.81(978.24-1597.94)0.708 CD3+T%72.62(69.32-76.96)71.62(64.97-75.25)0.135CD8+T436.40(342.71-596.86)513.50(359.73-620.53)0.665CD8+T%24.26(19.48-31.27)26.50(20.67-32.90)0.535CD4+T741.00(562.78-1095.52)664.50(585.52-789.97)0.428CD4+T%45.00(33.97-51.48)39.36(33.78-43.30)0.032Th1162.32(108.11-216.61)144.27(81.52-161.66)0.094Th1%19.00(15.24-25.54)18.46(14.86-24.27)0.644Th27.82(5.35-11.78)8.25(5.32-10.87)0.817Th2%1.00(0.76-1.27)1.24(0.89-1.64)0.399Th177.90(5.20-12.23)5.60(3.12-8.47)0.010Th17%1.13(0.70-1.55)0.77(0.43-1.07)0.026Treg24.45(19.76-44.79)34.55(27.29-46.57)0.076Treg%3.37(2.82-5.65)4.96(4.18-6.34)0.003Th1/Th220.00(13.78-36.36)14.97(10.31-21.58)0.135Th1/Treg5.72(2.92-8.86)3.68(2.53-4.77)0.021Th2/Treg0.27(0.16-0.52)0.22(0.15-0.32)0.199Th17/Treg0.29(0.16-0.46)0.15(0.08-0.23)0.002Conclusion:Th17/Treg immune disorder exists in IgG4-RD patients, and it is related to the disease activity, indicating that Th17/Treg imbalance may be an important pathogenesis of IgG4-RD.References:[1]Kamisawa T, Zen Y, Pillai S, et al. IgG4-related disease[J]. Lancet, 2015, 385(9976): 1460-1471.Disclosure of Interests:None declared

Background:Rheumatoid arthritis (RA) is a systemic autoimmune disease. It is characterized by highly disabling polyarthritis, but extra-articular features are also common and portend a poor prognosis. Compared with the general population, the incidence and mortality of cardiovascular disease in RA are significantly increased. Chronic autoimmune inflammation is the common pathogenesis of RA and coronary heart disease(CAD). We’ve proved that lymphocyte subsets imbalance and high cytokines expression play an important role in the occurrence and development of RA diseases. However, the level of lymphocyte subsets and cytokines of RA patients with CAD are rarely reported[1-2].Objectives:To explore the clinical characteristic of lymphocyte subsets and cytokines of RA patients with CAD,and make comparisons with simple RA patients and healthy controls.Methods:The study included 96 patients with a diagnosis of RA according to the 1987 revised criteria of the ACR, including 54 RA patients with CAD and 42 RA patients without CAD and other cardiovascular disease, 40 healthy controls are also concluded. The absolute numbers of lymphocyte subsets and T subsets in peripheral blood were measured by Flow Cytometer (FCM). Serum levels of IL-2, IL-4, IL-6, IL-10, IL-17, INF-γ, and TNF-α were measured by flow microsphere capture chip technique (CBA) for 19 RA patients with CAD and 38 simple RA patients among 96 patients.We also collected relevant clinical information and made DAS28 score, and all patients are in the middle-high disease activity group (DAS28>3.2).Results:(1) There was no difference in DAS28 scores between the two groups(p=0.572). (2)Compared with RA patients without CAD, the absolute number of total T cell(P=0.035), total B cell (P=0.006), CD4+T cell(P=0.012), Th1 cell(P=0.037), Th17 cell(P=0.033) and CD4+CD25+FOXP3+ Treg(P=0.003) was lower than RA patients with CAD, the number of NK cell(P=0.685), CD8+T cell(P=0.322) and Th2 cell(P=0.770) had no obvious difference between them. (3)Compared with the healthy control, the absolute number of total T cell(P=0.014), total B cell (P=0.006), CD8+T cell(P=0.000) in RA with CAD was evidently lower, but there was no siginificant difference in absolute number of CD4+T cell(P=0.582), Th1 cell(P=0.052), Th2 cell(P=0.595), Th17 cell(P=0.148) and Treg(P=0.176) (Figure 1).(4) In RA patients with CAD,the level of cytokines IL-2(P=0.042), IL-4(P=0.043) and IL-17(P=0.012) was lower, while other cytokines had no difference (Table 1).Figure 1.The absolute number of lymphcytes of RA patients with CAD(n=54),RA patients without CAD (n=42) and healthy control (n=40). (*P<0.05,**P<0.01, ***P<0.001).Table 1.The expression level of cytokines of RA patients with CAD(n=19) and RA patients without CAD (n=38).Cytokines (pg/ml)RA and CAD group(A) (n = 19)RA group(B) (n = 38)PvalueA vs. BIL-25.50(1.96, 12.82)6.82(4.45, 14.44)0.042IL-44.93(1.67, 9.41)6.28(4.49, 11.88)0.043IL-623.69(10.93, 73.08)36.67(15.40, 72.50)0.636IL-107.76(4.54, 10.50)7.62(5.69, 19.91)0.223IL-1710.81(4.04, 20.25)20.68(13.88, 45.58)0.012IFN-γ6.10(3.27, 13.84)7.13(5.79, 15.83)0.115TNF-α10.49(2.50, 29.04)14.96(10.03, 30.39)0.097Conclusion:Our research shows that there is lymphocyte imbalance and immune disorder existing in RA patients with CAD. Both the number of lymphocyte subsets and cytokine levels decreased in these patients than pure RA patients. It suggests that this group may be in lower immune state, which providing guidance for further clinical treatment of RA patients with CAD.References:[1]Winchester R, Giles JT, Nativ S, et al. Association of Elevations of Specific T Cell and Monocyte Subpopulations in Rheumatoid Arthritis With Subclinical Coronary Artery Atherosclerosis. [J]. Arthritis Rheumatol, 2016,68(1): 92-102.[2]England BR, Thiele GM, Anderson DR, et al. Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications. [J]. BMJ, 2018 04 23;361.Disclosure of Interests:None declared

Background:Rheumatoid arthritis (RA) is a chronic inflammatory disease which can lead to severe joint damage and disability.The relationship between antibodies and rheumatoid arthritis has long been well established. Recently, many studies have found that T follicular regulatory cells(Tfr) and T follicular helper cells (Tfh) are closely related to antibody generation on lymphoid follicular germinal centers (GCs)[1-2]. Tfr cells can inhibite the GC reaction and suppress production of high-affinity antibodies. The dysregulation of Tfh cells can lead to the production of autoantibodies by B cells.Objectives:To examine the expression of circulating T follicular regulatory cell (Tfr) and T follicular helper cell and its subsets(Tfh1 Tfh2 Tfh17) in RA patients and healthy control group.Methods:Level of Tfr and Tfh1,Tfh2 and Tfh17 cells in the peripheral blood of 17 new RA patients, 30 treated RA patients and 18 healthy controls were deceted by flow cytomery. All patients were hospitalised at the Department of Rheumatology, Second Hospital of Shanxi Medical University.Results:We found that the level of Tfr (CD3+CD4+CD25+CXCR5+FOP3+) percent(P=0.020), in the peripheral blood in RA patients were significantly decreased compared with healthy controls. The percent of Tfh (CD3+CD4+CXCR5+CD45RA-) (P=0.039)and Tfh17 (CD3+CD4+CXCR5+CD45RA-CXCR3-CCR6+) (P=0.000)were increased, but there are no statistical difference about Tfh1(CD3+CD4+CXCR5+CD45RA-CXCR3+CCR6-)(P=0.558) and Tfh2 (CD3+CD4+CXCR5+CD45RA-CXCR3-CCR6-) percent(P=0.079). We compared the above indicators between new and treated RA patients, and the results indicated that the Tfr(P=0.013),Tfh (P=0.002) and Tfh1(P=0.034) were significantly increased in the new RA patients compared to the treated RA patients, there were no differences between the two groups in Tfh2(P=0.419) and Tfh17 percent(P=0.124).Conclusion:Our results indicated that disorder of Tfr and Tfh subsets were involved in RA, restoring the Tfr/Tfh balance may be the potential therapeutic targets.Fig. 1.Comparison of Tfr, Tfh and its subsets(Tfh1 Tfh2 Tfh17) percent among the RA patients (n = 47) and healthy control group (n = 18) (*P < 0.05).Fig. 2.Comparison of Tfr,Tfh and its subsets(Tfh1 Tfh2 Tfh17) percent among the new RA patients (n = 17) and treated RA patients(n = 30) (*P < 0.05).References:[1]Deng J, Wei Y, Fonseca VR, Graca L, Yu D.T follicular helper cells and T follicular regulatory cells in rheumatic diseases[J].Nat Rev Rheumatol. 2019, 15(8):475-490.[2]Chen Liu, Dongwei Wang, Songsong Lu, et al.Increased Circulating Follicular Treg Cells Are Associated With Lower Levels of Autoantibodies in Patients With Rheumatoid Arthritis in Stable Remission.Arthritis Rheumatol. 2018, 70(5):711-721Disclosure of Interests:None declared