The Importance of The Inflammatory Cytokines IL21, TNF-Α, IL6, And IL17A to The Flow Activity and Progression of Ankylosing Spondylitis Patients Treated With Anti-TNF Therapy

Introduction: Ankylosing spondylitis (AS) is a
prevalent inflammatory rheumatic condition that impacts the
axial skeleton, resulting in distinctive inflammatory back pain,
which can lead to structural and functional limitations and a
reduction in quality of life. This study sought to determine the role
of the inflammatory cytokines IL21, TNF-α, IL6 and IL17A in the
flow activity and progression of ankylosing spondylitis in patients
being treated with anti-TNF drugs.
Method: A prospective case-control study was conducted at
Basrah Teaching Hospital in southern Iraq. Eighty-one AS
patients were divided into two groups: 67 were treated with anti
TNF therapy, 14 were newly diagnosed patients as positive
controls, and 65 were healthy individuals. Disease activity was
assessed using the AS Bath Disease Activity Index (BASDAI).
Conventional radiography and MRI are used to measure the
severity of the disease. IL-6, IL-17A, IL-21, and TNF-α were
extracted from serum samples using ELISA.
Result: IL-21 had the highest difference between groups (p =
0.001), but IL6 had the highest combined significant difference (p
= 0.001), with the most remarkable difference found between
positive control and healthy individuals (p = 0.001). The only
difference was between the positive control and healthy groups (p
= 0.006) for both IL17A and TNF-α. There was a moderately
positive correlation between serum levels of IL-21 and IL6 and
BASDAI. There was a moderately negative relationship (-0.634)
between the type of treatment and serum IL-21 levels and a
moderately positive relationship (0.64) between sacroiliitis and
IL21.
Conclusion: For the flow of AS activity and progression, the level
of IL21 in the serum is more important than the level of IL6 in the
serum, but there was no statistically significant difference in
IL17A and TNF-α levels.