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Hadwen B, Yu R, Cairns E, Barra L. Presence of Autoantibodies in Males and Females With Rheumatoid Arthritis: A Systematic Review and Metaanalysis. J Rheumatol 2022; 49:663-671. [PMID: 35293336 DOI: 10.3899/jrheum.211020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is more common in females, and although the cause of RA is unknown, it is characterized by the production of autoantibodies. The aims of this study were to determine whether RA-associated autoantibodies are more often found in females than males and to identify factors that influence the relationship between sex and seropositivity. METHODS Databases were searched and studies of RA (N ≥ 100) were included if they reported proportion of seropositive patients with RA by sex. Metaanalyses and metaregression were conducted using the random-effects model. Covariates regressed were smoking, age, BMI, Health Assessment Questionnaire-Disability Index (HAQ-DI), and the Disease Activity Score in 28 joints (DAS28). RESULTS Eighty-four studies with a total of 141,381 subjects with rheumatoid factor (RF) seropositivity and 95,749 subjects with anticitrullinated protein antibody (ACPA) seropositivity met inclusion criteria. The mean age of participants ranged from 37 to 68 years and the proportion of female subjects ranged from 9% to 92%. Results indicated that females were less likely than males to be seropositive: odds ratio (OR) 0.84 [95% CI 0.77-0.91] for RF and OR 0.88 [95% CI 0.81-0.95] for ACPA. BMI, smoking, mean age, DAS28, and HAQ-DI did not affect the relationship between sex and seropositivity. CONCLUSION Although studies report that females have higher RA disease activity than males and that seropositivity predicts worse outcomes, females were less likely to be seropositive than males.
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Affiliation(s)
- Brook Hadwen
- B. Hadwen, BMSc, Department of Epidemiology and Biostatistics, Western University
| | - Richard Yu
- R. Yu, MD, Department of Medicine, Division of Rheumatology, Western University
| | - Ewa Cairns
- E. Cairns, PhD, Department of Medicine, Division of Rheumatology, and Department of Microbiology and Immunology, Western University
| | - Lillian Barra
- L. Barra, MD, Department of Epidemiology and Biostatistics, Department of Medicine, Division of Rheumatology, and Department of Microbiology and Immunology, Western University, London, Ontario, Canada.
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Ebel AV, Lutt G, Poole JA, Thiele GM, Baker JF, Cannon GW, Gaffo A, Kerr GS, Reimold A, Schwab P, Singh N, Richards JS, Ascherman DP, Mikuls TR, England BR. Association of Agricultural, Occupational, and Military Inhalants With Autoantibodies and Disease Features in US Veterans With Rheumatoid Arthritis. Arthritis Rheumatol 2021; 73:392-400. [PMID: 33058561 PMCID: PMC8236239 DOI: 10.1002/art.41559] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/02/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the association of inhalant exposures with rheumatoid arthritis (RA)-related autoantibodies and severity in US veterans. METHODS Participants in the Veterans Affairs Rheumatoid Arthritis (VARA) registry were mailed surveys assessing occupational, agricultural, and military inhalant exposures. Demographic characteristics, disease activity, functional status, and extraarticular features were obtained from the VARA registry, while HLA-DRB1 shared epitope (SE) status, anti-cyclic citrullinated peptide (anti-CCP) antibodies, and rheumatoid factor (RF) were measured using banked DNA/serum from enrollment. Associations between inhalant exposures and RA-related factors (autoantibodies, severity, and extraarticular features) were assessed using multivariable linear and logistic regression models adjusted for age, sex, race, and tobacco use and stratified by SE status. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS Questionnaires were returned by 797 of 1,566 participants (50.9%). Survey respondents were older, more often White or male, and less frequently smokers, and had lower disease activity compared to nonrespondents. Anti-CCP positivity was more common among veterans exposed to burn pits (OR 1.66 [95% CI 1.02, 2.69]) and military waste disposal (OR 1.74 [95% CI 1.04, 2.93]) independent of other factors. Among participants who were positive for SE alleles, burn pit exposure (OR 5.69 [95% CI 2.73, 11.87]) and military waste disposal exposure (OR 5.05 [95% CI 2.42, 10.54]) were numerically more strongly associated with anti-CCP positivity. Several inhalant exposures were associated with the presence of chronic lung disease, but not with the presence of RF or the level of disease activity. CONCLUSION Military burn pit exposure and military waste disposal exposure were independently associated with the presence of anti-CCP antibodies in RA patients. These findings are consistent with emerging evidence that various inhalant exposures influence autoantibody expression and RA risk.
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Affiliation(s)
- Ariadne V. Ebel
- Ariadne V. Ebel, DO, Jill A. Poole, MD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH, Bryant R. England, MD, PhD: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Gabrielle Lutt
- Gabrielle Lutt: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, and University of Nebraska Lincoln
| | - Jill A. Poole
- Ariadne V. Ebel, DO, Jill A. Poole, MD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH, Bryant R. England, MD, PhD: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Geoffrey M. Thiele
- Ariadne V. Ebel, DO, Jill A. Poole, MD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH, Bryant R. England, MD, PhD: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Joshua F. Baker
- Joshua F. Baker, MD, MSCE: Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia
| | - Grant W. Cannon
- Grant W. Cannon, MD: VA Salt Lake City Health Care System and University of Utah, Salt Lake City
| | - Angelo Gaffo
- Angelo Gaffo, MD, MSPH: Birmingham VA Medical Center and University of Alabama at Birmingham
| | - Gail S. Kerr
- Gail S. Kerr, MD: Washington, DC VA Medical Center, Georgetown University, and Howard University, Washington, DC
| | - Andreas Reimold
- Andreas Reimold, MD: Dallas VA Medical Center and University of Texas Southwestern, Dallas
| | - Pascale Schwab
- Pascale Schwab, MD: VA Portland Healthcare System and Oregon Health & Science University, Portland
| | - Namrata Singh
- Namrata Singh, MD, MSCI: University of Washington, Seattle
| | - J. Steuart Richards
- J. Steuart Richards, MBBS, Dana P. Ascherman, MD: VA Pittsburgh Health Care and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dana P. Ascherman
- J. Steuart Richards, MBBS, Dana P. Ascherman, MD: VA Pittsburgh Health Care and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ted R. Mikuls
- Ariadne V. Ebel, DO, Jill A. Poole, MD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH, Bryant R. England, MD, PhD: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Bryant R. England
- Ariadne V. Ebel, DO, Jill A. Poole, MD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH, Bryant R. England, MD, PhD: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
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Bély M, Apáthy Á. Pancreatitis in rheumatoid arthritis and the role of systemic vasculitis of autoimmune origin in the pathogenesis of pancreatitis – A postmortem clinicopathologic study of 161 patients. ACTA ACUST UNITED AC 2019. [DOI: 10.15406/ghoa.2019.10.00351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
IgM and IgA autoantibodies binding to IgG are called rheumatoid factors (RFs) and occur with high frequency in rheumatoid arthritis (RA) and with lower frequency in other autoimmune diseases. RFs have diagnostic and prognostic value in RA, but they also have a high potential to cause false positive reactions in other immunoassays, especially sandwich assays. For these reasons it is imperative to be able to measure RFs in serum samples from patients suspected of RA or other autoimmune diseases and in serum samples to be analyzed by sandwich immunoassay for various clinical parameters. Here, a simple ELISA for IgM and IgA RFs is described.
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Esaily HA, Hewala AESA, Soliman SG, Galbat EA, Al-Ela DHA. Evaluation of serum undercarboxylated osteocalcin in premenopausal rheumatoid arthritis patients: its correlation with disease activity and bone mineral density. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2016. [DOI: 10.4103/1110-161x.189822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Holm BE, Sandhu N, Tronstrøm J, Lydolph M, Trier NH, Houen G. Species cross-reactivity of rheumatoid factors and implications for immunoassays. Scandinavian Journal of Clinical and Laboratory Investigation 2014; 75:51-63. [DOI: 10.3109/00365513.2014.965738] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Eilertsen GØ, Nikolaisen C, Becker-Merok A, Nossent JC. Interleukin-6 promotes arthritis and joint deformation in patients with systemic lupus erythematosus. Lupus 2011; 20:607-13. [DOI: 10.1177/0961203310392432] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The underlying mechanisms for the subsets of self-limiting, intermittent or chronic and deforming arthritis in systemic lupus erythematosus (SLE) are not well understood. We performed a cross-sectional analysis of pro-inflammatory cytokines (IL-1β, IL-2, IL-6, IL-8 and TNF-α) and joint status in 47 SLE patients (79% females, age 42 years, disease duration 8.6 years). All cytokines levels were significantly elevated in SLE patients compared with controls, but only IL-2 and IL-8 levels were higher than in patients with rheumatoid arthritis. SLE patients with ongoing synovitis (19%) and joint deformities (11%) had increased erythrocyte sedimentation rate (ESR), IL-6 and anti-dsDNA Ab levels. IL-6 levels correlated with ESR, anti-dsDNA Ab and haemoglobin, but not with C-reactive protein levels. Arthritis constitutes a considerable burden of disease in SLE over time, and joint deformations are associated with longstanding disease and arthritis flare rates. IL-6 is a potential biomarker and therapeutic target in the prevention of joint damage in SLE arthritis.
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Affiliation(s)
- GØ Eilertsen
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Norway
| | - C Nikolaisen
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Norway
| | - A Becker-Merok
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Norway
| | - JC Nossent
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Norway
- Department of Rheumatology, University Hospital Northern Norway, Tromsø, Norway
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Cardiovascular disease is associated with extra-articular manifestations in patients with rheumatoid arthritis. Clin Rheumatol 2009; 28:767-75. [DOI: 10.1007/s10067-009-1145-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 02/17/2009] [Accepted: 02/24/2009] [Indexed: 12/14/2022]
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Liu W, Li X, Ding F, Li Y. Using SELDI-TOF MS to identify serum biomarkers of rheumatoid arthritis. Scand J Rheumatol 2008; 37:94-102. [PMID: 18415765 DOI: 10.1080/03009740701747152] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES No satisfactory biomarkers are currently available to screen for rheumatoid arthritis (RA). We have developed and evaluated surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) for detection and analysis of multiple proteins for distinguishing individuals with RA from control individuals. METHODS A total of 156 serum samples from 90 RA patients, 30 patients with ankylosing spondylitis (AS), and 36 healthy individuals were examined by SELDI technology. Spectral data were analysed by the support vector machine (SVM) approach and potential biomarkers were chosen for system training and were used to construct a diagnostic model. RESULTS Pattern 1, consisting of four protein peaks with m/z values of 3899, 4594, 7566, and 13,842, distinguished RA from the healthy samples with sensitivity of 90.0% and a specificity of 91.7%. Pattern 2, consisting of m/z peaks 4287 and 6471, distinguished RA from AS with a sensitivity of 86.7% and a specificity of 85.0%. CONCLUSION The combination of SELDI-TOF MS and SVM could facilitate the discovery of better biomarkers for RA and also provide a useful tool for molecular diagnosis in the future.
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Affiliation(s)
- W Liu
- Department of Rheumatology, Shandong University Qilu Hospital, Jinan, P.R. China
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Becker-Merok A, Kalaaji M, Haugbro K, Nikolaisen C, Nilsen K, Rekvig OP, Nossent JC. Alpha-actinin-binding antibodies in relation to systemic lupus erythematosus and lupus nephritis. Arthritis Res Ther 2007; 8:R162. [PMID: 17062137 PMCID: PMC1794505 DOI: 10.1186/ar2070] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 09/25/2006] [Accepted: 10/24/2006] [Indexed: 12/25/2022] Open
Abstract
This study investigated the overall clinical impact of anti-α-actinin antibodies in patients with pre-selected autoimmune diseases and in a random group of anti-nuclear antibody (ANA)-positive individuals. The relation of anti-α-actinin antibodies with lupus nephritis and anti-double-stranded DNA (anti-dsDNA) antibodies represented a particular focus for the study. Using a cross-sectional design, the presence of antibodies to α-actinin was studied in selected groups, classified according to the relevant American College of Rheumatology classification criteria for systemic lupus erythematosus (SLE) (n = 99), rheumatoid arthritis (RA) (n = 68), Wegener's granulomatosis (WG) (n = 85), and fibromyalgia (FM) (n = 29), and in a random group of ANA-positive individuals (n = 142). Renal disease was defined as (increased) proteinuria with haematuria or presence of cellular casts. Sera from SLE, RA, and Sjøgren's syndrome (SS) patients had significantly higher levels of anti-α-actinin antibodies than the other patient groups. Using the geometric mean (± 2 standard deviations) in FM patients as the upper cutoff, 20% of SLE patients, 12% of RA patients, 4% of SS patients, and none of the WG patients were positive for anti-α-actinin antibodies. Within the SLE cohort, anti-α-actinin antibody levels were higher in patients with renal flares (p = 0.02) and correlated independently with anti-dsDNA antibody levels by enzyme-linked immunosorbent assay (p < 0.007) but not with other disease features. In the random ANA group, 14 individuals had anti-α-actinin antibodies. Of these, 36% had SLE, while 64% suffered from other, mostly autoimmune, disorders. Antibodies binding to α-actinin were detected in 20% of SLE patients but were not specific for SLE. They correlate with anti-dsDNA antibody levels, implying in vitro cross-reactivity of anti-dsDNA antibodies, which may explain the observed association with renal disease in SLE.
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Affiliation(s)
- Andrea Becker-Merok
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Breivika, N-9037 Tromsø, Norway
| | - Manar Kalaaji
- Department of Biochemistry, Institute of Medical Biology, University of Tromsø, Breivika, N-9037 Tromsø, Norway
| | - Kaia Haugbro
- Department of Biochemistry, Institute of Medical Biology, University of Tromsø, Breivika, N-9037 Tromsø, Norway
| | - Cathrin Nikolaisen
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Breivika, N-9037 Tromsø, Norway
| | - Kirsten Nilsen
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Breivika, N-9037 Tromsø, Norway
| | - Ole Petter Rekvig
- Department of Biochemistry, Institute of Medical Biology, University of Tromsø, Breivika, N-9037 Tromsø, Norway
- Department of Rheumatology, University Hospital of North Norway, Tromsø, Breivika, N-9038 Tromsø, Norway
| | - Johannes C Nossent
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Breivika, N-9037 Tromsø, Norway
- Department of Rheumatology, University Hospital of North Norway, Tromsø, Breivika, N-9038 Tromsø, Norway
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Becker-Merok A, Nikolaisen C, Nossent HC. B-lymphocyte activating factor in systemic lupus erythematosus and rheumatoid arthritis in relation to autoantibody levels, disease measures and time. Lupus 2007; 15:570-6. [PMID: 17080911 DOI: 10.1177/0961203306071871] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Overexpression of B-lymphocyte activating factor (BAFF) results in arthritis, glomerulonephritis and autoantibody formation in mice, but its role in human autoimmune disease is less obvious. Serum BAFF levels in patients with systemic lupus erythematosus (SLE) (n=42) and rheumatoid arthritis (RA) (n=60) were related to levels of disease activity, anti-dsDNA Ab, anti-ENA Ab, rheumatoid factor (RF) and anti-CCP Ab. BAFF levels were also followed over time in 19 SLE patients. BAFF levels correlated inversely with age, were higher in SLE than RA (median 2.7 versus 1.4 ng/mL, P < 0.01) and more SLE than RA patients had increased BAFF levels (57% versus 10%, P < or = 0.01). In SLE, BAFF levels correlated with SLEDAI scores but not with anti-dsDNA Ab levels. SLE patients with increased BAFF levels had higher SLEDAI and CRP levels. In RA, BAFF levels correlated weakly with anti-CCP levels (Rs 0.27, P = 0.07), but not with joint counts, ESR, CRP or RF levels. Longitudinal BAFF levels remained unaltered in two thirds of SLE patients and changes in BAFF levels were unrelated to disease flares. These findings suggest that BAFF stimulation of B-cells may contribute to SLE by other mechanisms than autoantibody production.
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Affiliation(s)
- A Becker-Merok
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Norway
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