Impaired cutaneous cell-mediated immunity in newly diagnosed rheumatoid arthritis.
BACKGROUND
Rheumatoid arthritis is characterized by an impaired immune response and a defective cutaneous cell-mediated immunity has been reported. This study was realised in order to determine the characteristics of cutaneous cell-mediated immunity in patients affected by recent-onset and untreated rheumatoid arthritis.


METHODS
Forty-eight patients affected by newly diagnosed rheumatoid arthritis were studied by skin testing with seven common recall antigens. The skin tests were performed before the administration of disease modifying anti-rheumatic drugs (methotrexate, cyclosporine-A, hydroxychloroquine) and were repeated after four months of therapy.


RESULTS
43.75% of the RA patients (21 out of 48) were defined as anergic compared with 2% of the normal control subjects and the rate of depression of cutaneous cell-mediated immunity was not related either with the markers of disease activity or with the clinical assessment. The impaired cutaneous cell-mediated immunity shows a slight improvement after methotrexate therapy, while cyclosporine-A and hydroxychloroquine were not able to achieve the same result.


CONCLUSIONS
Rheumatoid arthritis shows a defective cutaneous cell-mediated immunity when the patients are studied in the early phase of the disease and before a second-line of therapy with disease modifying anti-rheumatic drugs. The anergy does not correlate either with the disease activity or with the short-term response to treatment. The prognostic significance of these data remains uncertain.
Coaccioli
S
S
Rheumatology Unit, Dept. of Internal Medicine, Perugia University, Santa Maria Hospital, Via T. di Joannuccio 21, 05100 Terni, TR, Italy. coacc@tin.it
Di Cato
L
L
Marioli
D
D
Patucchi
E
E
Pizzuti
C
C
Ponteggia
M
M
Puxeddu
A
A
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000276:immunology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000276:immunology*; D012882:Skin Tests