Cytokine Profile in Synovial Fluid (SF) as Major Duration Predictor of Intra-Articular Corticosteroid (IAC) Injection in Juvenile Arthritis

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Presentation Number:2175

Presentation Time:11/11/2007 11:15:00 AM

Title:Cytokine Profile in Synovial Fluid (SF) as Major Duration Predictor of

Intra-Articular Corticosteroid (IAC) Injection in Juvenile Arthritis

Category:11. Pediatric rheumatology clinical and therapeutic disease

Author(s): Taddio1, Marcella Montico2, T. Fawcett3, L.

Maduskuie3, Marco Cattalini4, Luca Ronfani2, AnneMarie C. Brescia5,

D. Rose5. 1Department of Sciences of Reproduction and Development, Institute

of Child Health IRCCS Burlo Garofolo, University of Trieste, Trieste, Italy;

2Epidemiology and Biostatistics Unit, Institute of Child Health IRCCS Burlo

Garofolo, Trieste, Italy; 3Immunology Laboratory, Department of Research; A.

I. duPont Hospital for Children, Wilmington, DE; 4Department of Pediatric

Immunology and Rheumatology, Pediatric Clinic, University of Brescia,

Brescia, Italy; 5Division of Rheumatology A. I. duPont Hospital for

Children, Department of Pediatrics, Jefferson University, Wilmington,

DE

Purpose. Intra-articular corticosteroid (IAC) is an important treatment

option for children with arthritis. Attempts to identify clinical or

laboratory markers that could predict IAC efficacy showed inconsistent

results. Our previous data suggest that IL-6 and IL-10 levels in synovial

fluid (SF) predict duration of IAC effect. The aim of this study is to

expand previous findings on cytokine profile in SF as a tool to predict

clinical response to IAC.

Methods. All patients who underwent IAC were invited to participate in a

prospective IRB-approved study with remnant synovial fluid. Records of those

patients with at least 6 months follow-up were reviewed. We selected

duration of effect of more than 6 months as our primary outcome measure. The

dependant variable was the number of days to flare (mild swelling or worse)

or last observation after IAC. The independent variables were SF levels of

IL-6, IL-1a, TNF-a, IL-2sr, MMP-3, IL-10 and TGF-B1 measured by ELISA.

Primary analysis was performed using only the first injection per patient.

For that purpose a logistic regression was constructed. In the secondary

analysis, performed using all injections as independent events, observations

were clustered within individuals; cluster option was used in the STATA

logistic regression analysis.

Results. 104 SF samples from 58 patients were obtained. Diagnosis included

JIA (42), Spondyloarthritis (5), Lyme arthritis (5), Psoriatic arthritis

(3), TRAPS (1), associated arthritis (1), Ulcerative colitis (1).

There were 39 females and 19 males. Mean age was 7.62 years. Mean time to

flare was 366.36 days. Higher levels of IL1-a and IL10 predicted outcome for

the primary analysis. Higher levels of IL10 and IL-2sr showed statistical

significance for the secondary analysis.

Conclusions. A higher concentration of IL-1a, IL-10 and IL-2sr in SF at the

time of injection predicted longer duration of effect of corticosteroid knee

injection in children with chronic arthritis. A collaborative prospective

study to assess the value of a composite score involving cell count,

differential and biomarkers levels in SF of children with JIA at the time of

IAC is underway.

Disclosures: A. Taddio, None; M. Montico, None; P.T. Fawcett, None; V.L.

Maduskuie, None; M. Cattalini, None; L. Ronfani, None; A.C. Brescia, None;

C.D. Rose, None.