CCR9+CD4+ T cells are associated with disease activity in patients with rheumatoid arthritis

An increase in CD4(+) T cells in the synovium is closely linked to the pathogenesis of rheumatoid arthritis (RA). We aimed to identify the possible causes of the elevated CD4(+) T cell levels and to explore the factors influencing disease activity in RA. Fifty-five RA patients, including 28 with active RA (ARA), 27 with inactive RA, and 22 healthy controls, were recruited for this study. The proportion of CCR9(+)CD4(+) T cells and the expression of chemokine receptor 9 (CCR9) on CD4(+) T cells were analyzed by flow cytometry. Enzyme-linked immunosorbent assay and chemiluminescent immunoassay were used to evaluate interleukin (IL)-17A and IL-6 levels, respectively. The proportion of CCR9(+)CD4(+) T cells and the expression of CCR9 on CD4(+) T cells increased significantly in peripheral blood (PB) and synovial fluid (SF) in ARA compared to those in inactive RA. Furthermore, SF contained more CCR9(+)CD4(+) T cells, IL-6, and IL-17A than PB in RA patients. Moreover, CD4(+) T cells in the PB of patients with RA, especially ARA, expressed more CCR9 and secreted more IL-6 and IL-17A after activation. Here, we also demonstrated that both the percentage of CCR9(+) cells in CD4(+) T cells and the expression of CCR9 on circulating CD4(+) T cells were positively correlated with erythrocyte sedimentation rate, hypersensitive C-reactive protein, rheumatoid factor, and anti-cyclic citrullinated peptide antibody. CCR9(+)CD4(+) T cells are elevated in PB and SF, and are associated with disease activity in patients with RA.