Immunological Profiles, Oxidative Stress Biomarkers and Plasma Cholinesterase Activities in Patients with Immune-Mediated Inflammatory Diseases Treated in a Clinic in Duhok, Iraq

Abstract Aim The purpose of the present study was to measure the levels of selected plasma biochemical variables among cases of immune-mediated inflammatory diseases (IMIDs), other than rheumatoid arthritis, treated in a clinic in the city of Duhok, Iraq, since such information is scarce in the region. Materials and Methods A case-control study on IMIDs patients treated in a clinic in Duhok, Iraq, was performed 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. The majority of patients (69%) received conventional therapy combined with biologic agents, whereas the remaining patients (31%) received only conventional medications. 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%). The values of CRP, IL-6 and TNF-Į 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 —mol/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 a 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. They are essential for better diagnosis, treatment, and management of IMIDs.