Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: The most important biomarker in GCA and PMR patients is increased erythrocytes sedimentation rate (ESR) and/ or increased serum level of C-reactive protein (CRP). However, ample evidence indicates that the ESR and CRP are not increased at diagnosis in a subset of patients [1, 2]. Furthermore, recent data indicate that the ability of these inflammatory markers to detect active disease during tapering of corticosteroid may be compromised . SinceT cell play a critical role in the development of both diseases , we set out to investigate cellular makers of T cell activation, proliferation and differentiation for their ability to detect active disease in patients with GCA and PMR.
Methods: CD4 counts, CD8 counts and absolute numbers of CD4 and CD8 T cell differentiation subsets were determined by flow cytometry in peripheral blood of 28 newly-diagnosed, untreated GCA/PMR patients, 16 corticosteroid treated GCA/PMR patients in remission and 25 healthy controls. Expression of the activation marker HLA-DR and proliferation marker Ki-67 determined. Receiver operating characteristic (ROC) analysis with area under the curve (AUC) and Spearman’s correlation coefficients were performed.
Results: CD4 T cell counts were decreased in newly-diagnosed GCA and PMR patients. Central memory CD4 T cells were decreased in GCA patients only, and terminally differentiated CD4 T cells in PMR patients only. In GCA patients, CD4 T cells showed increased percentages of HLA-DR+ and Ki-67+ cells. No modulations were observed in the CD8 T cell compartment of GCA and PMR patients. Eleven CD4 T cell parameters provided only moderate discrimination between newly-diagnosed GCA/PMR patients and healthy controls, as indicated by AUC’s of 0.7-0.8. Of these markers only the percentage of Ki-67+ terminally differentiated CD4 T cells in GCA patient normalized during remission, and correlated weakly with the ESR and CRP.
Conclusion: Although the CD4 T cell compartment was modulated in GCA and PMR patients, cellular markers of CD4 T cell activation, proliferation and differentiation are not useful for detecting active GCA and PMR.
1. Salvarani C, Cantini F, Niccoli L, et al. Acute-phase reactants and the risk of relapse/recurrence in polymyalgia rheumatica: a prospective followup study. Arthritis Rheum 2005; 53(1):33-8.
2. Kermani TA, Schmidt J, Crowson CS, et al. Utility of erythrocyte sedimentation rate and C-reactive protein for the diagnosis of giant cell arteritis. Semin Arthritis Rheum 2012; 41(6):866-71.
3. Kermani TA, Warrington KJ, Cuthbertson D, et al. Disease Relapses among Patients with Giant Cell Arteritis: A Prospective, Longitudinal Cohort Study. J Rheumatol 2015; .
4. Weyand CM, Goronzy JJ. Immune mechanisms in medium and large-vessel vasculitis. Nat Rev Rheumatol 2013; 9(12):731-40.
To cite this abstract in AMA style:van der Geest KSM, Abdulahad WH, Wang Q, Roffel M, Horst G, Rutgers A, Boots AMH, Brouwer E. T Cell Activation, Proliferation and Differentiation Markers Lack Diagnostic Accuracy for Detecting Active GCA and PMR [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/t-cell-activation-proliferation-and-differentiation-markers-lack-diagnostic-accuracy-for-detecting-active-gca-and-pmr/. Accessed November 14, 2019.
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