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.