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Switched Memory B Cells Are Increased in Oligoarticular and Polyarticular Juvenile Idiopathic Arthritis and Their Change Over Time Is Related to Response to Tumor Necrosis Factor Inhibitors
Author(s) -
Marasco Emiliano,
Aquilani Angela,
Cascioli Simona,
Moneta Gian Marco,
Caiello Ivan,
Farroni Chiara,
Giorda Ezio,
D'Oria Valentina,
Marafon Denise Pires,
MagniManzoni Silvia,
Carsetti Rita,
De Benedetti Fabrizio
Publication year - 2018
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.40410
Subject(s) - medicine , methotrexate , interquartile range , arthritis , tumor necrosis factor alpha , gastroenterology , immunology
Objective To investigate whether abnormalities in B cell subsets in patients with juvenile idiopathic arthritis ( JIA ) correlate with clinical features and response to treatment. Methods A total of 109 patients diagnosed as having oligoarticular JIA or polyarticular JIA were enrolled in the study. B cell subsets in peripheral blood and synovial fluid were analyzed by flow cytometry. Results Switched memory B cells were significantly increased in patients compared to age‐matched healthy controls ( P < 0.0001). When patients were divided according to age at onset of JIA , in patients with early‐onset disease (presenting before age 6 years) the expansion in switched memory B cells was more pronounced than that in patients with late‐onset disease and persisted throughout the disease course. In longitudinal studies, during methotrexate ( MTX ) treatment, regardless of the presence or absence of active disease, the number of switched memory B cells increased significantly (median change from baseline 36% [interquartile range {IQR} 15, 66]). During treatment with MTX plus tumor necrosis factor inhibitors ( TNF i), in patients maintaining disease remission, the increase in switched memory B cells was significantly lower than that in patients who experienced active disease (median change from baseline 4% [IQR −6, 32] versus 41% [IQR 11, 73]; P = 0.004). The yearly rate of increases in switched memory B cells was 1.5% in healthy controls, 1.2% in patients who maintained remission during treatment with MTX plus TNF i, 4.7% in patients who experienced active disease during treatment with MTX plus TNF i, and ~4% in patients treated with MTX alone. Conclusion Switched memory B cells expand during the disease course at a faster rate in JIA patients than in healthy children. This increase is more evident in patients with early‐onset JIA . TNF i treatment inhibits this increase in patients who achieve and maintain remission, but not in those with active disease.