Immunological profiles, oxidative stress biomarkersand plasma cholinesterase activities in patients with immune-mediated inflammatory diseasestreated in a clinic in Duhok, Iraq.ES IN DUHOK, IRAQ

Abstract

Abstract. Aim: The purpose of the present study was to measure levels of selected plasma biochemical variables among cases of immune-mediated inflammatory diseases (IMIDs) other than rheumatoid arthritis in the city of Duhok, Iraq, since such information is scarce in the region. Methods: This was a case-control study on IMIDs patients in Duhok, Iraq from February 2022 to June 2023. A total of 29 patients of both genders with IMIDs and 61 healthy controls were recruited at the Duhok Center for Rheumatic Diseases and Medical Rehabilitation, Duhok, Iraq. The laboratory tests conducted on plasma samples from IMIDs patients and healthy controls included measurements of interleukin-6 (IL-6), tumor necrosis factor (TNF)-alpha, malondialdehyde (MDA), total antioxidant status (TAS) and cholinesterase (ChE) activity. Results: No significant differences were found in gender distribution, age, and body mass index between the IMIDs patients and healthy controls. Most of the patients (69%) received conventional therapy combined with biologic agents, whereas the remaining (31%) received conventional medications only. The IMIDs identified among the 29 patients were Behcet’s disease (27.6%), ankylosing spondylitis (24.1%), inflammatory bowel diseases (24.1%), psoriatic arthritis (10.3%), systemic lupus erythematosus (6.9%) and psoriasis (6.9%). Conventional therapy used was mostly azathioprine (44.8%) and methotrexate (17.2%), whereas biological therapy included mostly etanercept (27.6%) and adalimumab (24.1%). Values of CRP, IL-6 and TNF-α among the IMIDs patients were not significantly different from those of the controls.  The oxidative stress biomarker MDA was elevated in IMID patients (2.93 ± 1.106 µmol/L vs. 2.52 ± 0.478) at a p value of 0.064 (though not significant). The TAS level (1.21 ± 0.422 mmol Trolox Equiv./L vs. 1.00 ± 0.338, p= 0.022) and plasma ChE activity (1.18 ± 0.50 ∆ pH/20 min vs. 0.83 ± 0.30, p= 0.001) were significantly higher in IMIDs patients compared to controls. Conclusions: The data suggest that oxidative stress and changes in plasma ChE activity might be part of the pathophysiological alterations among IMIDs patients. Therapeutic drug monitoring and its clinical outcome as well as response of IMIDs patients to anti-ChE agents are worth of further in depth exploration and pursuing. These are essential for better diagnosis, treatment, and management of IMIDs.