Arthritis in systemic lupus erythematosus is characterized by local IL-17A and IL-6 expression in synovial fluid

Author:

Sippl N1ORCID,Faustini F1,Rönnelid J2ORCID,Turcinov S1ORCID,Chemin K1ORCID,Gunnarsson I1ORCID,Malmström V1ORCID

Affiliation:

1. Division of Rheumatology, Department of Medicine, Center of Molecular Medicine, Karolinska University Hospital Solna, Karolinska Institute, Stockholm, Sweden

2. Department Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden

Abstract

Summary Arthritis is a common clinical feature of systemic lupus erythematosus (SLE) and is usually non-erosive, as opposed to rheumatoid arthritis (RA). While RA synovial pathology has been extensively studied, little is known about the pathophysiology of lupus arthritis. Here, we aimed to explore the cytokine and cellular compartments in synovial fluids of SLE patients with arthritic manifestations. Acellular synovial fluid and paired serum samples from SLE patients (n = 17) were analyzed with cytokine bead array for T helper-associated cytokines. From two SLE patients, synovial fluid mononuclear cells (SFMC) could also be captured and were analyzed by multiparameter flow cytometry to dissect T cell, B cell, monocyte and dendritic cell phenotypes. SLE-derived SFMC were further stimulated in vitro to measure their capacity for producing interferon (IFN)-γ and interleukin (IL)-17A. All patients fulfilled the ACR 1982 classification criteria for SLE. Clinical records were reviewed to exclude the presence of co-morbidities such as osteoarthritis or overlap with RA. IL-17A and IL-6 levels were high in SLE synovial fluid. A clear subset of the synovial CD4+ T cells expressed CCR6+, a marker associated with T helper type 17 (Th17) cells. IL-17A-production was validated among CD4+CCR6+ T cells following in-vitro stimulation. Furthermore, a strong IFN-γ production was observed in both CD4+ and CD8+ cells. Our study shows high IL-17A and IL-6 levels in synovial fluids of patients with lupus arthritis. The Th17 pathway has been implicated in several aspects of SLE disease pathogenesis and our data also point to Th17 involvement for lupus arthritis.

Funder

King Gustaf V's 80-year Foundation

Ingegerd Johansson's Foundation

The Swedish Rheumatism Association

The Swedish Research Council

Stockholms Läns Landsting

Publisher

Oxford University Press (OUP)

Subject

Immunology,Immunology and Allergy

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