The aim of the study was to estimate serum pro-inflammatory cytokines concentration: TNF alpha and IL-6 as well as anti-inflammatory cytokine levels: IL-10 and IL-1ra in patients with Graves' disease and ophthalmopathy before and during glucocorticoid therapy. Serum cytokines were detected in three groups of subjects: 20 patients with Graves' disease without ophthalmopathy (GD), 17 patients with clinical symptoms of ophthalmopathy (GO) (CAS > or = 3, anamnesis of GO > or = 1 yr) and 24 healthy volunteers. Glucocorticoid therapy consisted of intravenous infusions of methyloprednisolone (MP) (2 series, 3 grams each time) and subsequent treatment with oral prednisone (60 mg per day) in a tapering schedule. The serum samples were collected 24 hours before MP, 24 hours after MP, 12 +/- 2 days of treatment with prednisone and at the end of glucocorticoid therapy. The levels of TNF alpha, IL-6, IL-10 and IL-1ra in the serum were determined by the ELISA method. The statistical significance was estimated by the Mann-Whitney U-test. Serum IL-6 level was increased in patients with GO in comparison to the controls and did not change significantly after immunosuppressive treatment. We did not find any significant differences of serum TNF alpha between the studied groups and glucocorticoids did not change its level significantly. Serum IL-10 was elevated significantly both in patients with GD and GO in comparison to the control group. IL-10 levels increased significantly after glucocorticoids. IL-1ra level was significantly higher in patients with GO. In the GO group we found an increase of IL-1ra after MP treatment and its gradual decline during prednisone therapy.
Conclusions: 1. The production of both: pro- and anti-inflammatory cytokines is increased in infiltrative Graves' ophthalmopathy 2. Efficient glucocorticoid therapy may be related to its influence on anti-inflammatory cytokines: IL-10 and IL-1ra.