1M Hafez, 2S Hawas, MF EL-Batouty, 1Z EL-Morsy, 1A Mansour, 1H AL-Marsafawy, and 4B EL-Deek.
Departments of 1Pediatrics, 2Microbiology and Medical Immunology, 3Rheumatology and Rehabilitation & 4Biostatistics and Community Medicine, Mansoura University.
This work investigates circulating tumour necrosis factor receptors (sTNFR) (P55 and P75) and Interleukin-2 receptors (IL-2R) in patients with active Juvenile rheumatoid arthritis (JRA), in a trial to evaluate their value in clinical assessment and response to treatment. The study included 44 children with JRA and 20 healthy controls. All patients had active disease defined by the presence of arthritis, and elevated C-reactive protein (CRP) and erythrocytic sedimentation rate (ESR) levels. Patients were enrolled according to their clinical diagnosis into three groups: G1, included 18 patients with polyarticular onset, G2; 18 with pauciarticular onset; and G3 with systemic onset. They entered a prospective and randomized double blind trial for therapy with either prednisone or non steroidal anti-inflammatory drugs (NSAIDS). sTNFR and sIL-2R were measured before and 48 weeks after heatment. The three receptors were significantly higher in active JRA as compared to healthy controls, regardless of the clinical types of JRA. However, significant reduction was demonstrated after treatment. On the other hand, no significant difference in the percentages of reductions was detected in patients treated by prednisone as compared to those treated with NSAIDs. Patients with marked improvement after treatment showed significant reduction (P < 0.001) in TNFR P55. In conclusion, TNFR, P55 may be a useful marker in the evaluation of clinical status and therapeutic response in patients with JRA.