Pulse steroid therapy may reduce macrophage activation in rheumatoid synovium

מתוך medicontext.co.il
NEW YORK (Reuters Health) – Pulse methylprednisolone therapy reduces expression of two beta-chemokines found in rheumatoid synovial membranes without producing a fall in macrophage numbers, according to a recent report. This suggests that PMP therapy reduces macrophage activation.

Dr. Peter P. Youssef, from the University of New South Wales in Australia, and colleagues studied the effect of pulse methylprednisolone therapy, 1000 mg, in seven patients with rheumatoid arthritis. Samples of the patients' synovial membranes were obtained arthroscopically before and 24 hours after therapy was given.

Previously the researchers had shown that high dose pulse steroid therapy causes a rapid improvement in disease activity associated with a reduction in neutrophil migration into the synovial space. However, the effects of this treatment on monocyte chemoattractant factor-1 (MCP-1) and macrophage inflammatory protein (MIP)-1alpha, two beta-chemokines, were unclear.

The researchers found that pulse methylprednisolone therapy produced a rapid and substantial decrease in levels of both beta-chemokines in the synovial lining layer. However, expression of CD68, a macrophage marker, was not affected. Furthermore, pulse methylprednisolone therapy had no effect on MCP-1, MIP-1alpha, and CD68 expression in the synovial sublining.

The current findings suggest that pulse methylprednisolone therapy's initial effect (within 24 hours) is to cause a reduction in macrophage activation. "It is possible that this would then be followed by a reduction in macrophage numbers due to a fall in macrophage chemokine expression," the authors state. Further studies, with later follow-up points after methylprednisolone administration are needed to determine this.

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