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Profiles of Cytokines (TNF and IL-6) and Acute Phase Proteins (CRP and 1AG) related to the Disease Course in Patients with Systemic Lupus Erythematosus

Department of Rheumatology, Dr Daniel den Hoed Clinic, PO Box 5201, 3008 AE Rotterdam

V. Huysen

Departrnent of Autoimmune Diseases, Central Laboratory of the Netherlands Red Cross Blood Transfusion Service, Plesmanlaan 125, 1066 CX Amsterdam, The Netherlands

R.T.J. Smeenk

Departrnent of Autoimmune Diseases, Central Laboratory of the Netherlands Red Cross Blood Transfusion Service, Plesmanlaan 125, 1066 CX Amsterdam, The Netherlands

A.J.G. Swaak

Department of Rheumatology, Dr Daniel den Hoed Clinic, PO Box 5201, 3008 AE Rotterdam

Tumor necrosis factor (TNF) and interleukin-6 (IL-6) play a main role in inducing acute phase protein production by hepatocytes. This study describes the serum levels of TNF and IL-6 in relation to serum levels of C-reactive protein (CRP) and 1-acid glycoprotein (1AG) in three systemic lupus erythematosus (SLE) patients. Disease courses of these patients were divided in a total of 19 clinical periods, according to the clinical symptoms and interleukine profiles. Significantly elevated TNF levels were found in all but three of the defined periods, without being associated with disease activity. In only four of the defined periods elevated TNF were observed combined with elevated IL-6 and CRP levels. Two of these periods coincided with minor symptoms of SLE, one with an exacerbation and the other one with a systemic infection while SLE activity was low. All other periods showed varying combinations of elevated TNF and/or IL-6 levels being followed or not by elevated CRP levels. Significantly raised 1AG levels were measured in all clinical periods. In most of the observed periods a dissociation was found between TNF and IL-6 and also between the different cytokine (TNF and IL-6) levels and acute phase protein (CRP and 1AG) levels. These data could not be explained by differences in disease course or influences of medication. We conclude that more factors other than TNF and IL-6 must play a role in the regulatory pathway of the acute phase response in SLE. These data are also highly suggestive of an imbalance between TNF, IL-6 and the acute phase reaction.

Key Words: TNF • IL-6 CRP • 1AG

Lupus, Vol. 2, No. 6, 359-365 (1993)
DOI: 10.1177/096120339300200605


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