The Chinese systemic lupus erythematosus (SLE) treatment and research group (CSTAR) provides major clinical characteristics of SLE in China and establishes a platform to provide resources for future basic and clinical studies. CSTAR originated as a multicentre, consecutive, and prospective design. The data were collected online from 104 rheumatology centers, which covered 30 provinces in China. The registered patients were required to meet four or more of the American College of Rheumatology (ACR) criteria for the classification of SLE. All CSTAR centers use the same protocol-directed methods to provide uniform evaluations, which included demographic data, clinical features, laboratory examinations, and disease activity evaluations. The patient samples, including DNA samples and sera, were also collected for further quality controls and additional studies. Preliminary analysis from 2104 baseline evaluations was available for this analysis. Of 1914 female and 190 male patients (F:M=10.1), the mean age at onset was 29.2 y with confirmed diagnosis one year later at the age of 30.3 y. Eighty four (4.2%) of 2002 patients had a family history of rheumatic diseases, including 34 (1.7%) cases with SLE. In addition, one hundred and seven (5.2%) abnormal pregnancies were recorded among 2026 experiences. The characteristics of the CSTAR cohort were compared to similarly sized cohorts from other studies. We found that 56.1% of patients presented with concurrent hematological disorders compared to only 18.2% of European patients. Moreover, 47.4% of patients presented with nephropathy compared to 27.9% of European patients. Conversely, neurological manifestations were only seen in 4.8% of Chinese SLE patients compared to 19.4% of European patients, 12.1% of U.S. patients, 22.8% of Malaysian patients and 26.4% of Latin Americans. Pulmonary arterial hypertension and interstitial lung diseases were complications identified in 3.8% and 4.2% of Chinese lupus patients, respectively. The CSTAR registry has provided epidemiological data and phenotypes of Chinese patients with SLE, and has demonstrated several differences between ethnicities. Clinical data and biologic samples would be valuable resources for future translational studies with national and international collaboration.

The possible prevalence of PAH was 3.8% in Chinese patients with SLE in the CSTAR registry. The significant association of pericarditis, pleuritis and anti-RNP positivity with PAH suggests that higher disease activity and vasculopathy may both contribute to the development of PAH in SLE, which need be treated aggressively to improve prognosis.

Renal disease, vasculitis and neuropsychiatric lupus are more common in male SLE patients with higher SLEDAI scores compared to female SLE patients in China.

BackgroundRecent studies have shown that increased number of Th17 cells and decreased number of Treg cells in the peripheral blood contribute to ankylosing spondylitis (AS). However, current therapy for AS, including biological agents, immunosuppressant and glucocorticoid, can not correct the imbalance of Th17 and Regulatory T (Treg) cells in AS patients effectively. It has been reported that low dose IL-2 can selectively expand Treg cells and had a critical effect on homeostatic balance between the Th17 and Treg cells.ObjectivesThe study is to explore the effect of low dose IL-2 therapy on the balance of Treg and Th17 cells in patients with AS and observe the efficiency and side effects of the therapy.MethodsSeventeen patients, who met the 1984 modified New York criteria and had evidence of active inflammatory spondylitis (defined as Bath AS Disease Activity Index (BASDAI) score >4) despite of receiving standard therapy including glucocorticoid, immune-suppressants, biological agents or combination of them, were enrolled. These patients were not only given traditional treatment, but also injected subcutaneously low-dose IL-2 (50 WIU/day for 5 days). Clinical and laboratory indicators were compared before and after IL-2 treatment. The side effects were observed in the course of therapy.ResultsThe number of Treg cells significantly increased after the treatment by 1 week (22.58±12.80 vs. 73.46±33.79, p<0.001). At the same time, there was a significantly decrease in the ratio of Th17/Treg cells (0.67±0.70 vs. 0.32±0.33, p=0.068). Besides, Th17 cells were also increased (12.83±9.24 vs. 19.26±13.24, p=0.054). Clinical manifestations were improved after the combination treatment of IL-2 and traditional drugs, especially BASDAI was decreased (4.57±0.61 vs. 1.98±0.83, P<0.001). No obvious adverse reactions were observed.ConclusionsLow dose IL-2 therapy can restore and maintain the balance of Th17 and Treg cells in the active patients with AS. Manifestation improved after the combination therapy. The therapy is safe. Further research is needed to investigate long term benefits of low-dose IL-2 therapy.References Wright P, Utriainen L, Milling S. Dendritic cells and regulatory T cells in spondyloarthritis. Curr Opin Rheumatol. 2013; 25(4):440–7.Zambrano-Zaragoza JF, Agraz-Cibrian JM, González-Reyes C, et al. Ankylosing spondylitis: from cells to genes. Int J Inflam. 2013; 2013:501653.Klatzmann D, Abbas AK. The promise of low-dose interleukin-2 therapy for autoimmune and inflammatory diseases. Nat Rev Immunol. 2015;15(5):283–94.He J, Zhang X, Wei Y, et al. Low-dose interleukin-2 treatment selectively modulates CD4(+) T cell subsets in patients with systemic lupus erythematosus. Nat Med. 2016;22(9):991–3. Disclosure of InterestNone declared

BackgroundA therapeutic revolution in the past decade is still a considerable unmet need in the treatment of rheumatoid arthritis (RA). On the other hand, dysfunction of regulatory T cells (Tregs) has been considered to be a pivotal cause of RA and correction of this dysfunction to be a potential RA therapy1. However, abnormalities of Tregs in patients with RA were reported controversially in previous studies2, in which only proportion was measured and Tregs were defined using different protein markers.ObjectivesIn this study, we measured both absolute numbers and proportions of CD4+CD25+Foxp3+ Tregs in peripheral blood of RA patients and investigated the effects of low-dose recombinant human IL-2 (rhIL-2) on Tregs and CD4+ effector T cell subsets in patients with RA.MethodsBoth absolute numbers and proportions of Treg and Th17 cells in peripheral blood, defined as the CD4+CD25+FOXp3+T or CD4+IL-17 + T cell population, were examined by flow cytometry in 342 patients with RA with different 28-joint Disease Activities (DAS28), including 75 who had never received disease-modifying antirheumatic drugs (DMARD) and 151 who were receiving or had received DMARD. Among these patients, 112 consented at enrollment to receive rhIL-2 treatment. Before and after treatment, the Th17 and Treg cells in peripheral blood were analyzed by flow cytometry.ResultsThe absolute count of Treg cells in patients with RA was significantly low compared with that of healthy controls (P<0.05), but the absolute count of Th17 cell was no different between RA and healthy controls. After the course of rhIL-2 treatment, there was a significant increase in the absolute count of Th17 and Treg cells in the CD4+ T cell population (P<0.01), but Th17/Treg was significantly low after the treatment.ConclusionsThe data suggest that, besides propotion, the decrease of Treg cell number, defined as the CD4+CD25+FOXp3+population, may contribute to the pathogenesis of RA. Over the treatment of rhIL-2, there was a more significant increase in the absolute count of Treg cells than that of Th17, and consequently restore the balance of Th17/Treg.References Miyara M, Ito Y, Sakaguchi S. TREG-cell therapies for autoimmune rheumatic diseases. Nature reviews Rheumatology 2014;10:543–51.Morita T, Shima Y, Wing JB, Sakaguchi S, Ogata A, Kumanogoh A. The Proportion of Regulatory T Cells in Patients with Rheumatoid Arthritis: A Meta-Analysis. PloS one 2016;11:e0162306. Disclosure of InterestNone declared