Second-line drug treatment in rheumatoid arthritis associated with depressed autologous mixed lymphocyte reaction

The AMLR (autologous mixed lymphocyte reaction) was performed in 24 control subjects, 41 patients with rheumatoid arthritis (RA), 19 patients with ankylosing spondylitis (AS), and 7 patients with psoriatic arthritis (PSA). It was found to be depressed in 21 of the RA subjects and this was linked to medication with sodium aurothiomalate or D-penicillamine. Addition of ultrapure interleukin 1 (IL-1), indomethacin, or catalase did not cause any improvement in the AMLR but some improvement was noted in those RA patients with subnormal AMLR when pure, recombinant interleukin 2 (IL-2) was added to the cultures. Since autoreactive T-cells are generated during the AMLR which are capable of providing help for immunoglobulin production, it is proposed that the defective AMLR seen after second-line drug treatment may be the mechanism whereby rheumatoid factor (RF) production is down-regulated during such treatment.