1.High mobility group protein B1(HMGB1) promotes myeloid dendritic cell maturation and increases Th17 cell/Treg cell ratio in patients with immune primary thrombocytopenia.
Qinzhi LI ; Dongsheng DUAN ; Xiujuan WANG ; Mingling SUN ; Ying LIU ; Xinyou WANG ; Lei WANG ; Wenxia FAN ; Mengting SONG ; Xinhong GUO
Chinese Journal of Cellular and Molecular Immunology 2025;41(1):45-50
Objective This study investigated the regulatory effect of high mobility group protein B1 (HMGB1) in the peripheral blood of patients with primary immune thrombocytopenia (ITP) on myeloid dendritic cells (mDC) and Th17/regulatory T cells (Treg) balance. Methods The study enrolled 30 newly diagnosed ITP patients and 30 healthy controls.Flow cytometry was used to measure the proportion of mDC, Th17, and Treg cells in the peripheral blood of ITP patients and healthy controls. ELISA was conducted to quantify the serum levels of HMGB1, interleukin 6 (IL-6), IL-23, IL-17, and transforming growth factor β(TGF-β). The mRNA levels of retinoic acid-related orphan receptor γt(RORγt) and forehead box P3(FOXP3) were detected by real-time PCR. The correlation between the abovementioned cells, cytokines, and platelet count was assessed using Pearson linear correlation analysis. Results The proportion of Th17 cells and the expression levels of HMGB1, IL-6, IL-23, IL-17 and the level of RORγt mRNA in the peripheral blood of ITP patients were higher than those in healthy controls. However, the Treg cell proportion and TGF-β level were lower in ITP patients than those in healthy controls. In patients with ITP, the proportion of mDC and the level of FOXP3 mRNA did not show significant changes. The proportion of mDC cells was significantly correlated with the expression of IL-6 and IL-23. Moreover, the expression of HMGB1 showed a significant correlation with the expression of mDC, IL-6, IL-23, RORγt mRNA, and IL-17. Notably, both the proportion of mDC cells and the expression of HMGB1 were negatively correlated with platelet count. Conclusion The high expression of HMGB1 in peripheral blood of ITP patients may induce Th17/Treg imbalance by promoting the maturation of mDC and affecting the secretion of cytokines, thereby potentially playing a role in the immunological mechanism of ITP.
Humans
;
Th17 Cells/cytology*
;
HMGB1 Protein/genetics*
;
T-Lymphocytes, Regulatory/cytology*
;
Female
;
Male
;
Dendritic Cells/metabolism*
;
Adult
;
Middle Aged
;
Purpura, Thrombocytopenic, Idiopathic/genetics*
;
Nuclear Receptor Subfamily 1, Group F, Member 3/genetics*
;
Young Adult
;
Interleukin-23/blood*
;
Interleukin-17/blood*
;
Interleukin-6/blood*
;
Forkhead Transcription Factors/genetics*
;
Myeloid Cells/cytology*
;
Aged
2.The IL-23p19 monoclonal antibody significantly alleviates nephritis in MRL/lpr lupus mice by modulating the Th17/Treg balance.
Wei CHENG ; Saizhe SONG ; Yu SHEN ; Cuiping LIU ; Xin CHANG ; Jian WU
Chinese Journal of Cellular and Molecular Immunology 2025;41(7):620-628
Objective To investigate the therapeutic effects of interleukin 23p19(IL-23p19) monoclonal antibody in the MRL/lpr lupus-like mouse model. Methods A total of 36 female MRL/lpr mice aged 8 weeks were randomly divided into 6 groups: PBS group (blank control), IgG group (isotype IgG), dexamethasone (DEX) group (positive control), and three IL-23p19 monoclonal antibody treatment groups with different dose gradients: low dose (LD, 1 mg/kg), medium dose (MD, 3 mg/kg), and high dose (HD, 10 mg/kg). Drug intervention began at 12 weeks of age via tail vein injection. Urine protein levels were measured using urine protein test strips; serum anti-dsDNA antibody levels were detected by ELISA; serum creatinine and blood urea nitrogen levels were measured using an automatic biochemical analyzer; renal histopathological changes were analyzed by H&E and PAS staining; immunofluorescence was used to assess IgG and C3 immune complex deposition in kidney tissues; flow cytometry was employed to examine the expression of T helper 1(Th1), Th2, Th17, T follicular helper (Tfh), and regulatory T cells(Treg) cell subsets in the spleen; and RT-qPCR was used to detect the expression of related transcription factors in the spleen. Results IL-23p19 monoclonal antibody reduced urine protein levels, alleviated splenomegaly, improved renal function, and decreased anti-dsDNA antibody levels in MRL/lpr mice. It also mitigated glomerulonephritis and reduced renal immune complex deposition. Furthermore, IL-23p19 monoclonal antibody significantly suppressed the proportion of Th1 and Th17 cells while upregulating Treg cell proportion in the spleen. Additionally, it downregulated T-bet and retinoic acid receptor-related orphan receptor γt (RORγt) mRNA levels and upregulated forkhead box P3(FOXP3) mRNA levels in the spleen. Conclusions IL-23p19 monoclonal antibody demonstrates significant therapeutic effects in MRL/lpr mice, likely through modulation of the Th17/Treg cell balance.
Animals
;
Female
;
Mice, Inbred MRL lpr
;
T-Lymphocytes, Regulatory/drug effects*
;
Th17 Cells/drug effects*
;
Antibodies, Monoclonal/therapeutic use*
;
Interleukin-23 Subunit p19/immunology*
;
Mice
;
Lupus Nephritis/drug therapy*
;
Kidney/drug effects*
;
Antibodies, Antinuclear/blood*
3.Influence of long-term biologic therapy on metabolic biochemical parameters in moderate to severe plaque psoriasis.
Xiangxian LIU ; Yi LIN ; Jinzhu GUO
Journal of Peking University(Health Sciences) 2025;57(5):934-940
OBJECTIVE:
To assess the impact of long-term biologic therapy on metabolic biochemical parameters in moderate to severe plaque psoriasis patients.
METHODS:
The study included patients over 18 years old who had been treated by biological agents for at least 24 weeks for moderate to severe plaque psoriasis from Novermber 2015 to January 2024. According to the biological agents the patients used, they were divided into three groups: interleukin-17 (IL-17) inhibitor group, IL-23 and IL-12/23 inhibitor group and tumor necrosis factor-α (TNF-α) inhibitor group. The metabolic biochemical parameters of each group were evaluated and compared before and after the administration of the biologic therapies.
RESULTS:
A total of 174 patients with moderate to severe plaque psoriasis were included in the long-term treatment with biologics, including 127 males (73.00%), 47 females (27.00%), with a median age of 38.00 (31.50, 49.00) years and a median duration of psoriasis of 12.00 (10.00, 20.00) years. The median duration of biologic treatment was 61.00 (49.00, 96.25) weeks, ranging from 26 to 301 weeks. There were 101 patients in the IL-17 inhibitor group, 38 patients in the IL-23 and IL-12/23 inhibitor group, and 35 patients in the TNF-α inhibitor group. After long-term treatment with IL-17 inhibitors, no statistically significant changes were observed in body weight, body mass index (BMI), alanine aminotransferase (ALT), aspartate aminotransferase (AST), fasting glucose (GLU), total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) compared with baseline measurements (P>0.05). However, low-density lipoprotein cholesterol (LDL-C) levels were significantly reduced [(2.90±0.75) mmol/L vs. (3.05±0.79) mmol/L, t=-2.100, P=0.038], while uric acid (UA) levels showed a significant increase [(401.13±99.13) μmol/L vs. (364.94±91.11) μmol/L, t=5.215, P < 0.001]. The group with normal UA levels before treatment showed a significant increase after long-term application of biological agents compared with before treatment [(370.69± 89.59) μmol/L vs. (324.66±64.50) μmol/L, t=5.856, P < 0.001]. Following long-term application of IL-23 and IL-12/23 inhibitors, no statistically significant differences were observed in body weight, BMI, ALT, AST, GLU, TC, TG, HDL-C and UA levels when compared with baseline measurements (P> 0.05). However, LDL-C levels exhibited a significant reduction from baseline [(2.85±0.74) mmol/L vs. (3.12±0.68) mmol/L, t=-2.082, P=0.045]. After long-term treatment with TNF-α inhibitor, there were no significant differences in body weight, BMI, ALT, AST, GLU, TC, TG, HDL-C, LDL-C and UA compared with baseline measurements (P>0.05).
CONCLUSION
Long-term application of IL-17 inhibitors in moderate to severe plaque psoriasis patients may result in elevated uric acid levels, particularly in patients with normal uric acid levels before treatment. The long-term use of IL-17 inhibitors, IL-23 inhibitors or IL-12/23 inhibitors might reduce LDL-C levels.
Humans
;
Psoriasis/blood*
;
Male
;
Female
;
Adult
;
Middle Aged
;
Interleukin-17/antagonists & inhibitors*
;
Interleukin-23/antagonists & inhibitors*
;
Tumor Necrosis Factor-alpha/antagonists & inhibitors*
;
Interleukin-12/antagonists & inhibitors*
;
Biological Therapy
;
Biological Products/therapeutic use*
;
Triglycerides/blood*
;
Cholesterol, LDL/blood*
;
Cholesterol, HDL/blood*
4.Expression of Th17 and IL-23 in Peripheral Blood and Their Relationship with Immunophenotype in Patients with Acute Myeloid Leukemia.
Zhi-Yuan PENG ; Chun-Xiu YANG ; Jing-Hui SAN ; Qing-Qun LI ; Min-Min ZHANG ; Bin SHI
Journal of Experimental Hematology 2022;30(4):1056-1062
OBJECTIVE:
To observe the expression of helper T cells 17(Th17), interleukin 23 (IL-23) in peripheral blood in patients with acute myeloid leukemia (AML), to analyze the relationship between Th17, IL-23 in peripheral blood and immunophenotype.
METHODS:
105 patients with AML in the hospital from January 2019 to January 2021 were prospectively selected as the research subjects, the expression of Th17 and IL-23 in peripheral blood of patients with AML was detected by flow cytometry; immunophenotype was detected and counted. The relationship between the expression of Th17, IL-23 in peripheral blood and immunophenotype of AML patients was analyzed. Draw ROC curve and analyze the predictive value of Th17 and IL-23 expression in peripheral blood to immunophenotype.
RESULTS:
The immunophenotype results of AML patients showed that myeloid antigen, lymphoid antigen and hematopoietic stem/progenitor cell marker antigen were positive expressed for various antigens in 105 AML patients, in myeloid antigens, CD13+ accounted for the highest proportion (93.33%), in lymphoid antigens, CD56+ accounted for the highest proportion (32.38%), and in hematopoietic stem/progenitor cell marker antigens, CD38+ accounted for the highest proportion (68.57%). The expression of Th17 in peripheral blood of AML patients with CD56+, CD7+, CD34+ and human leukocyte antigen DR+(HLA-DR+) were higher than that of AML patients with CD56-, CD7-, CD34-, HLA-DR-, the expression of IL-23 in peripheral blood of AML patients with CD56+, CD34+ and HLA-DR+ were higher than that of AML patients with CD56-, CD34-, HLA-DR-, the differences were statistically significant (P<0.05); compared the expression of Th17 and IL-23 in peripheral blood between other antibody positive and negative patients, there was no statistical significant difference (P>0.05). Logistic regression analysis showed that the high expression of Th17 in patients with AML was related to the positive expression of CD56, CD7, CD34 and HLA-DR in the detection of immunophenotype, the high expression of IL-23 was related to the positive expression of CD56, CD34 and HLA-DR in the detection of immunophenotype. The ROC curve showed that the AUC of expression levels of Th17 and IL-23 in peripheral blood alone and in combination for predicting CD56+, CD34+, HLA-DR+ and Th17 in peripheral blood for predicting CD7+ were mostly 0.5-0.7, which had certain predictive value, but the predictive performance was low.
CONCLUSION
Myeloid antigen, lymphoid antigen and hematopoietic hematopoietic stem/progenitor cell marker antigen are positive expressed for various antigens in AML patients, the high expression of Th17 in peripheral blood of AML patients is related to the positive expression of CD56, CD7, CD34 and HLA-DR in detection of immunophenotyping, the high expression of IL-23 is related to the positive expression of CD56, CD34 and HLA-DR in the detection of immunophenotype.
Antigens, CD34
;
Flow Cytometry/methods*
;
HLA-DR Antigens/analysis*
;
Humans
;
Immunophenotyping
;
Interleukin-23
;
Interleukin-23 Subunit p19/blood*
;
Leukemia, Myeloid, Acute/genetics*
;
Th17 Cells
5.Expression of T-helper 17 cells and signal transducers in patients with psoriasis vulgaris of blood-heat syndrome and blood-stasis syndrome.
Bin FAN ; Xin LI ; Kan ZE ; Rong XU ; Ruo-Fei SHI ; Lin GENG ; Fu-Lun LI ; Yi-Fei WANG ; Jie CHEN ; Bin LI
Chinese journal of integrative medicine 2015;21(1):10-16
OBJECTIVETo investigate the levels of cytokines related to T-helper (Th) 17 cells in serum and signal transducers in the psoriatic lesions of patients with psoriasis vulgaris of blood-heat syndrome (BHS) and blood-stasis syndrome (BSS).
METHODSSixty patients with psoriasis vulgaris were divided into the BHS and BSS groups according to the syndrome differentiation of Chinese medicine (CM). Ten healthy subjects were considered as the control group. Cytokine levels of interleukin (IL)-17, IL-23 and IL-6 in serum were determined by enzyme-linked immunosorbent assay. Expression levels of signal transducer and activator of transcription 3 (STAT3), p38-mitogen-activated protein kinase (MAPK) and STAT6 in the psoriatic lesions were determined using immunohistochemistry (IHC), Western blot, and real-time quantitative reverse transcription polymerase chain reaction, respectively.
RESULTSProduction of IL-17, IL-23 and IL-6 in the BHS group and BSS group were significantly increased compared with those in the control group (P<0.05). Levels of IL-17 and IL-23 in the BHS group were higher than those in the BSS group (P<0.05). Compared with the control group, IHC positive expressions and protein expressions of STAT3 and p38-MAPK, and the STAT3 mRNA expressions in the BHS and BSS groups were significantly higher (P<0.05 or P<0.01). The protein expression of STAT3 in the BHS group was significantly higher than that in the BSS group (P<0.05).
CONCLUSIONSCytokines in serum and signal transducers in the psoriatic lesions alter with various CM syndromes of psoriasis. The results provide scientific basis for the treatment based on syndrome differentiation of CM in treating psoriasis vulgaris.
Adult ; Female ; Gene Expression Regulation ; Humans ; Immunohistochemistry ; Interleukin-17 ; blood ; Interleukin-23 ; blood ; Interleukin-6 ; blood ; Male ; Psoriasis ; blood ; enzymology ; genetics ; immunology ; RNA, Messenger ; genetics ; metabolism ; STAT3 Transcription Factor ; genetics ; metabolism ; STAT6 Transcription Factor ; genetics ; metabolism ; Signal Transduction ; Syndrome ; Th17 Cells ; immunology ; p38 Mitogen-Activated Protein Kinases ; genetics ; metabolism
6.Effects of hemoperfusion treatment on serum IL-23 and IL-17 levels in children with Henoch-Schönlein purpure.
Li LIU ; Yan-Ping HUANG ; Xia-Ling FANG ; Yuan-Yuan ZHANG ; Ning CHEN ; Hong-Hong HOU
Chinese Journal of Contemporary Pediatrics 2015;17(8):796-799
OBJECTIVETo study the effects of hemoperfusion treatment on serum interleukin-17 (IL-17) and IL-23 levels in children with Henoch-Schönlein purpura (HSP).
METHODSEighty-seven children who were diagnosed with HSP and who had received hemoperfusion treatment between January 2011 and December 2012 were enrolled. Twenty-seven sex- and age-matched healthy children were recruited as normal controls. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum concentrations of IL-17 and IL-23.
RESULTSThe serum IL-23 and IL-17 levels in the HSP group were significantly higher than in the control group (P<0.05). After hemoperfusion treatment, the serum IL-23 and IL-17 levels in the HSP group were significantly reduced to the levels of the control group. Serum serum IL-17 level was positively correlated with serum IL-23 level (P<0.05) in children with HSP.
CONCLUSIONSHemoperfusion treatment can reduce serum IL-23 and IL-17 levels in children with HSP, suggesting that the treatment may be effective for HSP.
Child ; Child, Preschool ; Female ; Hemoperfusion ; Humans ; Interleukin-17 ; blood ; physiology ; Interleukin-23 ; blood ; physiology ; Male ; Purpura, Schoenlein-Henoch ; immunology ; therapy
7.Abnormal expression of IL- 23/IL- 17 axis in peripheral blood of 45 patients with primary immune thrombocytopenia.
Cheng QIAN ; Qingya CUI ; Anmei DENG ; Qin QIN ; Haifei CHEN ; Hongshi SHEN ; Zhaoyue WANG ; Chuanlu REN ; Tianqin WU
Chinese Journal of Hematology 2015;36(12):1035-1038
OBJECTIVETo investigate the expression of IL- 23/IL- 17 axis in peripheral blood of patients with primary immune thrombocytopenia (ITP) and its clinical significance.
METHODSThe real-time quantitative reverse transcription-polymerase chain reaction(RT-PCR)was used to determine the expression of IL-23p19, p40, p35, IL-23R, IL-12Rβ1, IL-12Rβ2, IL-17A, IL-17F mRNA in the peripheral blood of 45 ITP patients and 30 healthy controls. The correlations between the expression of IL-23 and IL- 17, platelet counts, serum cytokine concentrations of ITP patients were analyzed. Furthermore, nine newly diagnosed ITP patients were followed up during treatment.
RESULTSThe gene expressions of IL-23p19, p40, IL-23R, IL-12Rβ1, IL-17A, IL-17F in ITP patients were significantly higher than those in healthy controls, the relative expression levels of ITP were 5.58, 2.13, 4.20, 2.45, 4.29, 2.50 times as much as that of healthy controls. And elevated serum IL-23[(198.70±94.56)ng/L vs(50.72±22.97)ng/L, t= 10.06, P<0.001], IL-17[(85.25±21.97)ng/L vs(11.39±4.27)ng/L, t=21.94,P<0.001]levels were also observed in these ITP patients. In addition, the serum IL-23 level in ITP patients was positively correlated with IL-17(r=0.496, P<0.01), but negatively correlated with the platelet counts(r=-0.408, P<0.01), and IL-17 level was negatively correlated with platelet counts(r=-0.464, P<0.01).
CONCLUSIONThe IL-23/IL- 17 expression in ITP patients was significantly elevated, indicating IL-23/IL-17 play an important role in the pathogenesis of ITP.
Case-Control Studies ; Cytokines ; blood ; Gene Expression ; Humans ; Interleukin-17 ; metabolism ; Interleukin-23 ; metabolism ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic ; metabolism ; RNA, Messenger
8.Expression level and significance of IL-17 and IL-23 in serum and nasal secretion of patients with allergic rhinitis and non-allergrie rhinitis.
Guang YANG ; Guoxi ZHENG ; Luyao ZHANG ; Kang ZHU ; Wenjun XIN ; Junrong WEI
Journal of Clinical Otorhinolaryngology Head and Neck Surgery 2015;29(12):1086-1090
OBJECTIVE:
To investigate the effect of IL-17 and IL-23 in the pathogenesis of allergic rhinitis(AR) and non. allergic rhinitis(NAR).
METHOD:
Selected 156 cases of patients with allergic rhinitis (AR group) and 59 cases of patients with non-allergic rhinitis (NAR group), 60 cases of healthy people (control group). All cases in AR group and NAR groups were evaluated by a visual analog scale (VAS) score of nasal symptoms. Collected peripheral blood and nasal secretions in all cases and then detected IL-17 and IL-23 expression levels.
RESULT:
There was no significant difference in VAS score of AR group and NAR group (P>0. 05). IL-17 and IL-23 levels of serum and nasal secretions in AR group and NAR group were both higher than control group, with a highly significant difference (P <0. 05). The research showed a clear correlation between expression of IL-17 and IL-23 both in serum and nasal secretions of AR group and NAR(P<0. 05).
CONCLUSION
IL-17 and IL-23 may be important cytokines and IL-23/IL-17 pathway may play a significant role in the pathogenesis of allergic rhinitis and non-allergic rhinitis.
Case-Control Studies
;
Humans
;
Interleukin-17
;
blood
;
metabolism
;
Interleukin-23
;
blood
;
metabolism
;
Nasal Mucosa
;
metabolism
;
Rhinitis
;
blood
;
metabolism
;
Rhinitis, Allergic
;
blood
;
metabolism
9.Effects of Shenshao Decoction on the inflammatory response in the aorta of a rat atherosclerotic model.
Zhong-Wen XUE ; Xiao-Ming SHANG ; Song-Hui LV ; Hong XU ; Qi ZHANG ; Chen WANG
Chinese journal of integrative medicine 2013;19(5):347-352
OBJECTIVETo investigate the effect of Shenshao Decoction on the inflammatory status: in the aorta in a rat model of atherosclerosis.
METHODSForty Sprague-Dawley rats were randomly divided into: five groups, 8 rats in each group: control untreated group, atherosclerosis group, atherosclerosis with Shenshao Decoction (low dose) group, atherosclerosis with Shenshao Decoction (high dose) group, atherosclerosis with simvastatin group. To stimulate atherosclerosis, the rats were fed vitamin D3 and a high-cholesterol diet. Four weeks later, treatments were maintained for eight weeks. Morphology changes were investigated by hematoxylin and eosin staining. Serum levels of total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) were obtained by enzymatic assays with use of an automated biochemical analyzer. The expression of malondialdehyde (MDA), glutathione peroxidase (GSH-PX) were detected by enzyme-enzymelinked immunosorbent assay. The expression levels of interleukin (IL)-1β, IL-17A, and IL-23 were detected by linked immunoblotting.
RESULTSShenshao Decoction treatment decreased TC, TG, LDL-C and MDA and increased: GSH-PX levels (P<0.01). Compared with the control group, IL-1β, IL-17A, and IL-23 were lower in the high and CONCLUSIONShenshao Decoction: could attenuate the progression of aortal atherosclerotic plaques by inhibiting the inflammatory response in a rat atherosclerotic model.
Animals
;
Aorta, Thoracic
;
drug effects
;
pathology
;
Atherosclerosis
;
blood
;
drug therapy
;
pathology
;
Cholesterol
;
blood
;
Cholesterol, LDL
;
blood
;
Disease Models, Animal
;
Drugs, Chinese Herbal
;
therapeutic use
;
Glutathione Peroxidase
;
blood
;
Immunohistochemistry
;
Inflammation
;
drug therapy
;
pathology
;
Interleukin-17
;
metabolism
;
Interleukin-1beta
;
metabolism
;
Interleukin-23
;
metabolism
;
Male
;
Malondialdehyde
;
blood
;
Rats
;
Rats, Sprague-Dawley
;
Triglycerides
;
blood
10.Increased interleukin-23 is associated with increased disease activity in patients with rheumatoid arthritis.
Ying-ying GUO ; Nai-zhi WANG ; Shuai ZHAO ; Lin-xin HOU ; Yan-bing XU ; Ning ZHANG
Chinese Medical Journal 2013;126(5):850-854
BACKGROUNDInterleukin-23 (IL-23) is a pro-inflammatory cytokine that is thought to be central to the development of autoimmune diseases. This study was conducted to determine whether or not the serum concentration of IL-23 is elevated in patients with rheumatoid arthritis (RA), and to determine the relationship between the IL-23 level and disease activity in RA patients.
METHODSSerum samples were obtained from 59 patients with RA and 30 healthy controls. The clinical parameters of disease activity were determined, including the 28-joint disease activity score (DAS28), C-reactive protein (CRP), rheumatoid factor (RF) levels, and the degree of bony erosions based on X-rays. The levels of IL-23 and IL-17 were determined by enzyme-linked immunosorbent assay (ELISA). The correlations between the serum levels of IL-23 and disease activity parameters of patients with RA were determined.
RESULTSThe serum IL-23 level was significantly elevated in patients with RA compared to healthy controls. The serum IL-23 levels in the RA patients correlated with IL-17 and CRP levels, and the DAS28. The levels of IL-23 based on X-ray classification phase I, II, III, and IV were gradually elevated in RA patients.
CONCLUSIONSThe levels of serum IL-23 in RA patients were higher than in healthy controls. Thus, elevated serum IL-23 levels may be useful markers to detect active RA. In addition, IL-23 is involved in disease progression and bony erosions in patients with RA.
Adult ; Aged ; Arthritis, Rheumatoid ; blood ; pathology ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Interleukin-23 ; blood ; Male ; Middle Aged

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