Imbalance between proinflammatory T-helper-1 (Th1) and anti-inflammatory T-helper-2 (Th2) cells and, subsequently, their products interferon-and interleukin 4, respectively, is believed to be important in the development of autoimmune diseases. Dominance of Th1 over Th2 cells is thought to be important in the pathogenesis of rheumatoid arthritis. 2, 3 We investigated whether the Th1/Th2 ratio in the peripheral blood of patients with rheumatoid arthritis is related to disease severity, measured by response to disease-modifying antirheumatic drugs (DMARDs).

We recruited patients with early rheumatoid arthritis (duration 1 year) who had not previously taken DMARDs. We determined disease activity by a modified disease activity score4 based on scores for 28 joints. 11 patients with high disease activity (scores 6· 0, median 6· 4 [range 6· 0–6· 9]) were started on DMARDs; ten on sulphasalazine (2000 mg/day), one on hydroxychloroquine (200 mg/day). We measured Th1/Th2 ratios in peripheral blood by intracellular staining assay with flowcytometric analysis. 5 The percentages of Th1 and Th2 cells were