Avaliação morfológica de neutrófilos de sangue periférico como possível biomarcador da evolução clínica de pacientes com artrite reumatoide

Resumo

Introduction: Rheumatoid Arthritis (RA) is a chronic and systemic inflammatory disease. It is characterized by the formation of cutaneous nodules, vasculitis and polyarticular synovitis with great deforming potential. Progression occurs through the formation of an extensive group of vessels in the synovial membrane induced by CD4+ T and CD8+ T cells, B cells, macrophages and neutrophils that undergo diapedesis and lodge in the synovial membrane, inducing neovascularization. In the current context, neutrophils with a ring nucleus have emerged. In humans, they are associated with myeloproliferative disorders. Their role is unknown. Objective: To evaluate the morphology of the peripheral blood neutrophil nucleus of patients with RA and correlate it with clinical data of these patients; Materials and Methods: The research was approved by the CEP, number 5.998.879, and all patients were recruited at the UFERSA Rheumatology Ambulatory . For the control group, volunteers of both sexes, with the same age as the patients, were recruited, with 16 patients with RA and 10 healthy individuals recruited. Patients' medical records were consulted, upon prior authorization. To perform the hematological slides, 5mL of peripheral blood was collected. The slides were prepared by blood smear, and after staining, they were analyzed under an optical microscope. Results: The average age of participants with RA was 57,8 years, with standard deviation=12,58. The average of healthy people was 43,6 years old, with standard deviation = 6,708.  With regard to the use of medications, the most used by patients were methotrexate, pregabalin and prednisone. The average number of ring neutrophils per group in healthy people was 8, with a standard deviation of 1,644. The average in patients with RA was 14, with a standard deviation of 6,171, and a value of p=0,0113. This supports previous studies on inflammatory disorders, including RA, that they can cause an increase in the number and activity of neutrophils. In the review by (WRIGHT, Helen L. et al, Frontiers in immunology, v. 11, p. 584116, 2021), it was found that neutrophils have an aberrant and activated phenotype in RA, characterized by increased production of reactive oxygen species , cytokines and delayed apoptosis. Furthermore, they found that in addition to having an activated phenotype in peripheral blood, neutrophils were found elevated in the synovial joints of patients with RA. Its presence in joints was accompanied by high levels of neutrophil granule proteins in synovial fluid, including myeloperoxidase (MPO) and cathepsin G (WRIGHT, Helen L. et al, Frontiers in immunology, v. 11, p. 584116, 2021.) . Conclusion: There is a relationship between AR and the number of ring neutrophils. This finding can act as a possible biomarker for evaluating the evolution of the disease.