The number of circulating monocytes as biomarkers of the clinical response to methotrexate in untreated patients with rheumatoid arthritis

Abstract

Background: The aim of this work was to analyze the number and distribution of circulating monocytes, and of their CD14 +high CD16 -, CD14 +high CD16 + and CD14 +low CD16 + subset cells, in treatment-naive patients with rheumatoid arthritis (RA), and to determine their value in predicting the clinical response to methotrexate (MTX) treatment. Methods: This prospective work investigated the number of circulating monocytes, and the numbers of CD14 +high CD16 -, CD14 +high CD16 + and CD14 +low CD16 + subset cells, in 52 untreated patients with RA before MTX treatment, and at 3 and 6 months into treatment, using flow cytometry. Results: The absolute number of circulating monocytes, and the numbers of CD14 +high CD16 -, CD14 +high CD16 + and CD14 +low CD16 + subset cells, were significantly higher in MTX non-responders than in responders and healthy controls before starting and throughout treatment. Responders showed normal numbers of monocytes, and of their subset cells, over the study period. The pre-treatment absolute number of circulating monocytes, and the numbers of CD14 +high CD16 - and CD14 +high CD16 + subset cells, were found to be predictive of the clinical response to MTX, with a sensitivity and specificity of >70% and >88%, respectively. Conclusions: Treatment-naive patients with RA showed an anomalous distribution of circulating monocyte subsets, and an anomalous number of cells in each subset. A higher pre-treatment number of circulating monocytes, and higher numbers of CD14 +high CD16 - and CD14 +high CD16 + subset cells, predict a reduced clinical response to MTX in untreated patients with RA.