Publications of Faculty of Medicine:Matrix metalloproteinases 3, 9 and tissue inhibitor metalloproteinase 1 in paired serum and synovial fluid samples of patients with early rheumatoid arthritis.: Abstract

The aim of this study is to determine serum and synovial fluid levels of stromelysin-1 (MMP3), gelatinase-B (MMP9) and TIMP1 in patients with early RA and to search for a relationship with disease activity and the rate of radiological progression. We measured MMP3, MMP9 and TEMPI levels using an enzyme linked immunosorbent assay (ELISA). Paired samples of scrum and synovial fluid (SF) were collected from 40 patients with RA presenting with knee effusion and 20 matched healthy subjects as a control group presenting with traumaticinon hemorrhagi^knee synovial effusion. Radiographs of the hands, wrists and forfeet were taken for all RA patient^ at baseline and after 2 years. Radiographic damage and scoring were evaluated according to Larsen-Dale index. There were significant elevation in the mean serum and SF levels of MMP3, MMP9 and TEMPI in RA patients at entry in comparison with the control group (P<0.001) for all comparisons except serum TEMPI (P<0.05) being 5.7, 2.1, 1.3 folds higher in serum and 122.3, 2b.5, 17.7 folds higher in the SF. The mean SF levels"of MMP3 and TEMPI in RA patients were significantly higher than their serum levels (PO.001)' being 266 and 12.3 folds higher respectively, as regard the MMP9 there was insignificant difference (P>0.05). The serum and SF levels of MMP3, MMP9 and TEMPI were significantly increased in higher grades of disease activity (P<0.001). According to Larsen grading at the entry of the study, 15 patients (38%): were grade I and 25 patients (62%) were grade II. There were higher serum MMP3 and higher SF Matrix metalloproteinases 3, 9 and tissue inhibitor metalloproteinase 1 in paired serum and synovial fluid samples of patients with early rheumatoid arthritis. MMP3, MMP9 and. TEMPI in patients with higher radiological grade of severity. At the end of the study, 18 RA patients (45%) showed radiological progression, there were highly significant elevations in the mean serum and SF levels of MMP3 (P<0.001) and significant elevation in the mean SF levels of MMP9 and TEMPI (P<0.05) in progressor group. Baseline values of the progressor group showing higher serum and SF levels of MMP3 (P<0.05), (P<0.001) and higher SF levels of MMP9 (P<0.05). In conclusion, this study shows that MMP3 and MMP9 have a role in joint inflammation and damage of RA. Baseline serum MMP3 and synovial fluid MMP3 and MMP9 levels predicted the progression of joint damage in RA of recent onset. Also, our results support the theory of the presence of an MMP/TEMP imbalance in arthritic diseases.