〔Abstract〕 Objective To investigate the expression of T-cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain(TIGIT) and programmed death 1(PD1) on follicular T helper cells(TFH) from the patients with rheumatoid arthritis(RA) and to analyze the clinical relevance to disease severity. Methods The expression of TIGIT and PD1 on TFH cells were examined from 79 RA patients and 45 healthy controls(HC) by the technique of flow cytometry. The expression of TIGIT and PD1 including percentage of TIGIT+TFH, PD1-TFH, TIGIT+PD1-TFH, TIGIT+PD1+TFH, TIGIT-PD1+TFH cells and the mean fluorescence intensity(MFI) on theses TFH cells were compared between RA patients and HC. Moreover, its correlation with laboratory inspection was analyzed. Results (1) The percentage of PD1+TFH and the MFI of PD1 on PD1+TFH from RA patients significantly increased compared with HC(P<0.01).(2) The percentage of TIGIT+PD1-TFH significantly decreased compared with HC(P<0.01), whereas the percentage of TIGIT+PD1-TFH, the MFI of PD1 on TIGIT+PD1-TFH, the percentage of TIGIT+PD1+TFH and the MFI of PD1 on TIGIT+PD1+TFH significantly increased(P<0.05).(3) The MFI of PD1 on TIGIT+PD1+TFH in RA patients was positively associated with rheumatoid factors(RF)(P<0.05). The percentage of TIGIT-PD1+TFH, the MFI of PD1 on TIGIT-PD1+TFH, the MFI of PD1 on TIGIT+PD1+TFH in RA patients were positively associated with increased RF(P<0.05).(4) The percentage of TIGIT+PD1-TFH in RA patients was negatively associated with erythrocyte sedimentation rate(ESR)(P<0.05). The percentage of TIGIT-PD1+TFH in RA patients was positively associated with ESR(P<0.05). The percentage of TIGIT+PD1+TFH in RA patients was negatively associated with lymphocyte count(Lym)(P<0.05). The MFI of PD1 on TIGIT+PD1+TFH in RA patients was negatively associated with lymphocyte percentage(Lym%), and positively associated with neutrophil count(Net), neutrophil percentage(Net%), neutrophilto-lymphocyte ratio(NLR), systemic immune inflammation index(SII), derived neutrophil to lymphocyte ratio(dNLR), ESR, C-reactive protein(CRP)(P<0.05). The MFI of PD1 on TIGIT-PD1+TFH in RA patients was positively associated with Net, ESR, CRP(P<0.05).(5) The percentage of TIGIT+PD1-TFH in RA patients was negatively associated with disease activity score 28(DAS28)-ESR(P<0.05). The MFI of PD1 on TIGIT+PD1+TFH and the MFI of PD1 on TIGIT-PD1+TFH in RA patients was positively associated with DAS28-ESR, DAS28-CRP, tender joint count(TJC), swollen joint count(SJC), patient visual analogue scale(VAS)(P<0.05).(6) Decreased percentage of TIGIT+PD1-TFH and increased percentage of TIGIT+PD1+TFH were risk of RA. Conclusion The decreased percentage of TIGIT+PD1-TFH, increased percentage of TIGIT+PD1+TFH and TIGIT-PD1+TFH were observed in patients with RA. Aberrations level of TIGIT+PD1-TFH, TIGIT+PD1+TFH, TIGIT-PD1+TFH were associated with the production of antibody, inflammation, and also disease activity.