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Background  The majority of CD4 +  T helper (Th) cells found in the synovial fluid (SF) of patients with rheumatoid arthritis (RA) express CXCR3, a receptor associated with Th1 cells. In blood, subsets of Th2 and Th17 cells also express CXCR3, but it is unknown if these cells are present in RA SF or how cytokines from these subsets affect cytokine/chemokine secretion by fibroblast-like synoviocytes (FLS) from patients with RA.    Methods  We examined the proportions of Th1, Th2, CXCR3 + Th2, Th17, CXCR3 + Th17, Th1Th17, peripheral T helper (TPh) and T follicular helper (TFh) cells in paired SF and blood, as well as the phenotype of TPh and TFh cells in RA SF ( n  = 8), by the use of flow cytometry. We also examined the cytokine/chemokine profile in paired SF and plasma ( n  = 8) and in culture supernatants of FLS from patients with chronic RA ( n  = 7) stimulated with Th-associated cytokines, by the use of cytometric bead arrays and ELISA. Cytokine receptor expression in FLS ( n  = 3) were assessed by the use of RNA sequencing and qPCR.    Results  The proportions of Th1 and CXCR3 + Th2 cells were higher in SF than in blood ( P  < 0.05). TPh and PD-1 high TFh in RA SF were primarily of a Th1 and a CXCR3 + Th2 phenotype. Moreover, the levels of CXCL9, CXCL10, CCL20, CCL2, CXCL8, IL-6 and IL-10 were higher in SF than in plasma ( P  < 0.05). Lastly, IL-4, IL-13 and IL-17A induced RA FLS to secrete proinflammatory IL-6, CCL2, CXCL1 and CXCL8, while IFNγ mainly induced CXCL10.    Conclusion  These findings indicate that not only Th1 but also CXCR3 + Th2 cells may have a pathogenic role in RA synovial inflammation.

T helper cells in synovial fluid of patients with rheumatoid arthritis primarily have a Th1 and a CXCR3+Th2 phenotype