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Synovial fl uid aspiration of patients with rheumatoid arthritis (RA) provides important information on the activity of the local infl ammation. Synovial T lymphocytes, including cells positive with ligands of death receptors, i.e. Fas ligand (FasL) and TRAIL (TNF-related apoptosis-inducing ligand), both of which play an important role in RA pathogenesis. The fi rst-line treatment of RA is methotrexate (MTX), but glucocorticoids (as prednisone) and non-steroid anti-infl ammatory drugs (NSAIDs) are also used. The impact of treatment on the immune profi le of synovial fl uid in RA has not yet been cleared. Objective: Characteristics of the infl uence of prednisone and MTX treatment on the cytoimmunological pattern of synovial fl uid in RA patients. Material and methods: Synovial fl uid was harvested from RA patients treated with prednisone (n=11) and MTX (n=6). The control group consisted of patients receiving NSAIDs only (n = 19). The total cell number (TCN), the percentage of leukocyte populations and the phenotype of lymphocytes, including FasL and TRAIL expression on Th and Tc cells, was analyzed. Results: In the prednisone and MTX-treated groups, a decline in TCN was found. The increased value of the CD4/CD8 index in the MTX group was statistically signifi cant, as compared to the NSAIDs-treated group (median: 1.2 vs 0.7, p<0.05). In prednisone-treated patients, a statistically signifi cant decrease in the percentage of lymphocytes T FasL+ and TRAIL+ was observed (i.e. median of CD8+TRAIL+ cells was 12.0% vs 19.2% in the NSAIDs-treated group, p<0.05, U-Mann-Whitney test). Conclusions: In the synovial fl uid of patients treated with prednisone, there was a decrease in the lymphocyte cytotoxicity markers compared to the group treated only with NSAIDs. Parallel changes in the MTX group were non-signifi cant. MTX seems to increase the value of the CD4/CD8 index, which can be interpreted as a result of CD8+ cytotoxic cell elimination. Cytological and immunological analysis of synovial fl uid may be useful to assess the effi cacy of local treatment.

Obraz cytoimmunologiczny płynu stawowego w reumatoidalnym zapaleniu stawów. Wstępna ocena wpływu leczenia metotreksatem i metyloprednizolonem