Increased helper inducer and decreased suppressor inducer phenotypes in the rheumatoid joint

Cells isolated from the joints of patients with rheumatoid arthritis (RA) exhibit functional immune abnormalities, such as diminished suppressor activity, depressed response to mitogens, and enhanced immunoglobulin production. We sought to characterize the T lymphocyte subsets in the synovial fluid (SF) and peripheral blood (PB) of RA patients in an attempt to clarify the mechanism(s) responsible for these functional immune abnormalities. We used dual-immunofluorescence staining techniques with several combinations of monoclonal antibodies, including anti-4B4 and anti-2H4, which define, respectively, the helper inducer and suppressor inducer subsets of CD4+ (Leu-3+ and T4+) cells. Mononuclear cells from normal PB (n = 9), RA PB (n = 6), and RA SF (n = 9) were analyzed, after staining, by flow cytometry. We observed a significant increase (P less than 0.0002) in the number of cells bearing the helper inducer phenotype (CD4+, 4B4+), and a significant decrease (P less than 0.0002) in the number of cells bearing the suppressor inducer phenotype (CD4+, 2H4+), in RA SF compared with the levels in PB from RA patients or normal control subjects. We also observed that the CD8+, 2H4+ subset was significantly decreased (P less than 0.0001) in SF compared with that in PB. There was no significant difference in the lymphocyte subset levels in PB from RA patients and from normal subjects. These observations may account, in part, for the reduced suppressor activity, the poor response to mitogens, and the autologous mixed lymphocyte reaction, as well as the enhanced production of Ig and rheumatoid factor, that are observed in the rheumatoid joint.