title: Preliminary study on the immunologic background of good clinical outcome in rheumatoid arthritis patients after one month therapy with leflunomide.
abstract: This preliminary study focuses on early peripheral cellular immune changes after 1 month therapy with leflunomide, in 18 patients with severe rheumatoid arthritis, previously treated with methotrexate. A good clinical outcome of disease was documented and we showed that a particular target of short-time leflunomide therapy in rheumatoid arthritis was the peripheral innate immune system (NK cells and the population of granulocytes developing phagocytosis and superoxide anion production when challenged ex vivo with zymosan particles). Meanwhile, the high inter-individual variability of adaptive immunity required data analysis in subgroups of patients. We showed that the abnormal increase of peripheral leukocytes counts, or the decrease towards normal values of the CD4:CD8 lymphocytes ratio, or the inhibition of uridine uptake by ex vivo activated lymphocytes were consistent with a positive clinical evolution, proved by the reduction of tender/swollen joints, morning stiffness duration or acute phase response. We emphasized that significant benefits of short-term leflunomide therapy were associated with functional suppression of peripheral B lymphocytes. Hence, the positive evolution of rheumatoid arthritis patients seemed to be specifically linked to early drug-induced changes of trafficking or uridine metabolism of mononuclear cells.
authors.affiliation: Immunology Department, Victor Babes National Institute of Pathology, 99-101 Splaiul Independentei, 050096, Bucharest, Romania. gina.manda@gmail.com
authors.forename: Gina
authors.initials: G
authors.lastname: Manda
authors.forename: Monica
authors.initials: M
authors.lastname: Neagu
authors.forename: Carolina
authors.initials: C
authors.lastname: Constantin
authors.forename: Ionela
authors.initials: I
authors.lastname: Neagoe
authors.forename: Catalin
authors.initials: C
authors.lastname: Codreanu
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology*; D001402:B-Lymphocytes / Q000276:immunology; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D016022:Case-Control Studies; D002452:Cell Count; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007113:Immunity, Innate; D007555:Isoxazoles / Q000627:therapeutic use*; D007694:Killer Cells, Natural / Q000276:immunology; D000077339:Leflunomide; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology; D016176:T-Lymphocyte Subsets / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D007555:Isoxazoles; D000077339:Leflunomide