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Serum anti-malondialdehyde-acetaldehyde IgA antibody concentration improves prediction of coronary atherosclerosis beyond traditional risk factors in patients with rheumatoid arthritis. Sci Rep 2022; 12:10547. [PMID: 35732827 PMCID: PMC9217813 DOI: 10.1038/s41598-022-14954-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/15/2022] [Indexed: 01/27/2023] Open
Abstract
Patients with rheumatoid arthritis (RA) have increased atherosclerosis; oxidative stress may be a contributor. Oxidative stress produces immunogenic malondialdehyde-acetaldehyde (MAA) protein adducts and anti-MAA antibodies are detectable in human serum. We hypothesized that anti-MAA antibody concentrations are associated with coronary atherosclerosis in RA patients. Serum concentrations of anti-MAA antibodies (IgA, IgG, and IgM) were measured in 166 RA patients using ELISA cross-sectionally. Relationship between anti-MAA antibody concentrations and cardiovascular and metabolic measures and predictive accuracy of anti-MAA antibodies for presence of coronary artery calcium (CAC) and high CAC (≥ 300 Agatston units or ≥ 75th percentile) were assessed. Only serum IgA anti-MAA antibody concentration was associated with increased CAC, insulin resistance, and decreased high-density lipoprotein particle number. When added as an interaction term with ACC/AHA 10-year risk score plus high-sensitivity C-reactive protein, IgA anti-MAA antibody concentration improved the C-statistic for prediction of any CAC and high CAC compared to ACC/AHA 10-year risk score plus hs-CRP alone. IgA anti-MAA concentration is associated with multiple cardiovascular risk factors and modifies the relationship between ACC/AHA 10-year risk score and CAC in RA patients. IgA anti-MAA concentration could assist in prediction of atherosclerotic CVD and risk stratification when added to standard measures of cardiovascular risk.
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Fedele AL, Petricca L, Tolusso B, Alivernini S, Canestri S, Di Mario C, Bosello SL, Ferraccioli G, Gremese E. Interleukin-6 and IgA-rheumatoid factor are crucial for baseline erosiveness, and anti-citrullinated peptide antibodies for radiographic progression in early rheumatoid arthritis treated according to a treat-to-target strategy. Scand J Rheumatol 2018. [PMID: 29542372 DOI: 10.1080/03009742.2017.1416668] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To define baseline clinical and immunological characteristics [anti-citrullinated peptide antibodies (ACPAs), immunoglobulin M (IgM)- and IgA-rheumatoid factor (RF), and interleukin-6 (IL-6) levels] involved in determining baseline erosiveness, outcome, and radiographic progression among seropositive and seronegative early rheumatoid arthritis (ERA) patients. METHOD The 408 ERA patients enrolled in the study were monitored every 3 months according to the treat-to-target strategy. At baseline and after 12 months, hand and foot radiographs were evaluated using the Sharp/van der Heijde erosion score. RESULTS At diagnosis, seronegative patients were older and had higher Disease Activity Scores (DASs) than seropositive patients. A higher risk of erosiveness at baseline was conferred by IgA-RF positivity and IL-6 plasma levels ≥7.6 pg/mL, particularly when simultaneously present. In multivariate analysis, disease duration and IL-6 plasma levels ≥7.6 pg/mL arose as independent variables associated with presence of erosions at onset. Radiographic progression at 1 year follow-up, which occurred in 11.1% of ERA patients, was predicted by ACPA positivity, together with higher age at diagnosis. Despite similar percentages of good European League Against Rheumatism response, DAS and Boolean remission being observed over time among seropositive and seronegative patients and between erosive and non-erosive subjects, ERA patients who were erosive at onset, IgA-RF seropositive, and simultaneously having high baseline IL-6 plasma levels (≥7.6 pg/mL) were treated to a greater extent with tumour necrosis factor blockers after 12 months. CONCLUSION IgA-RF positivity and IL-6 plasma levels are crucial for baseline erosiveness, while ACPA positivity represents the strongest risk factor for developing radiographic progression in ERA.
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Affiliation(s)
- A L Fedele
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
| | - L Petricca
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
| | - B Tolusso
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
| | - S Alivernini
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
| | - S Canestri
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
| | - C Di Mario
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
| | - S L Bosello
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
| | - G Ferraccioli
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
| | - E Gremese
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
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Rheumatoid factor false positivity in patients with ANCA-associated vasculitis not having medical conditions producing rheumatoid factor. Clin Rheumatol 2017; 37:2771-2779. [PMID: 29119480 DOI: 10.1007/s10067-017-3902-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/24/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
We investigated the rate of rheumatoid factor (RF) false positivity at diagnosis and its influence on clinical and prognostic features and rheumatoid arthritis (RA) development during the follow-up in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients without RA or other medical conditions triggering RF false positivity. We reviewed the medical records of 128 AAV patients. We divided patients with AAV and each variant into two groups according to RF positivity and compared variables between the two groups. Odds ratio and cumulative relapse-free survival rate were obtained by multivariate logistic regression analysis and the Kaplan-Meier survival analysis, respectively. The mean age at diagnosis was 53.6 years and 41 patients were male. Of 128 AAV patients, 69 patients (53.9%) were classified as microscopic polyangiitis (MPA), 29 (22.7%) as granulomatosis with polyangiitis (GPA) and 30 (23.4%) as eosinophilic GPA (EGPA). The rate of RF false positivity was 39.1% in AAV patients. On univariate analysis, general, cutaneous and mucous and ocular manifestations and myeloperoxidase (MPO)-ANCA (or perinuclear (P)-ANCA) positivity were associated with RF false positivity in patients with AAV. On multivariate analysis, cutaneous manifestation was the only independent predictor of RF false positivity in EGPA patients. RF false positivity had no influence on cumulative relapse-free survival rate of AAV or RA development during the follow-up. RF false positivity rate was 39.1% in AAV patients and it was associated with cutaneous manifestation in EGPA patients at diagnosis, but not relapses of AAV or RA development during the follow-up.
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Majka DS, Vu THT, Pope RM, Teodorescu M, Karlson EW, Liu K, Chang RW. Association of Rheumatoid Factors With Subclinical and Clinical Atherosclerosis in African American Women: The Multiethnic Study of Atherosclerosis. Arthritis Care Res (Hoboken) 2017; 69:166-174. [DOI: 10.1002/acr.22930] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 04/06/2016] [Accepted: 04/26/2016] [Indexed: 01/01/2023]
Affiliation(s)
- Darcy S. Majka
- Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Thanh-Huyen T. Vu
- Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Richard M. Pope
- Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Marius Teodorescu
- TheraTest Laboratories; University of Illinois College of Medicine; Chicago
| | | | - Kiang Liu
- Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Rowland W. Chang
- Northwestern University Feinberg School of Medicine; Chicago Illinois
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Lindenberg L, Spengler L, Bang H, Dorner T, Maslyanskiy AL, Lapin SV, Ilivanova EI, Martinez-Gamboa L, Bastian H, Wittenborn E, Egerer K, Burmester GR, Feist E. Restrictive IgG antibody response against mutated citrullinated vimentin predicts response to rituximab in patients with rheumatoid arthritis. Arthritis Res Ther 2015; 17:206. [PMID: 26268352 PMCID: PMC4535682 DOI: 10.1186/s13075-015-0717-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 07/14/2015] [Indexed: 01/24/2023] Open
Abstract
Introduction Antibodies against mutated citrullinated vimentin (AMCV) represent a useful diagnostic marker with correlation to disease activity in patients with rheumatoid arthritis (RA). Since seropositivity for citrullinated autoantibodies was predictive for response to B-cell depleting therapy (BCDT) with rituximab (RTX), we investigated whether differences in antibody fine reactivity and immunoglobulin (Ig) isotype kinetics among AMCV-positive patients could provide additional information about outcome. Methods A total of 50 AMCV IgG-positive RA patients (RTX responders (RRs) n = 37 and non-responders (NRRs) n = 13) were analyzed for reactivity against MCV epitopes and co-existent AMCV isotypes IgM and IgA. Antibody titers were determined by enzyme-linked immunosorbent assay at baseline and 24 weeks after the first cycle of RTX, and compared to kinetics of rheumatoid factor (RF) and antibodies against cyclic citrullinated peptide (ACCP). Results Recognized MCV epitopes by AMCV IgG of RRs and NRRs showed similar baseline patterns, with reducing reactivity in RRs and unchanged or even expanding reactivity in NRRs upon RTX treatment. At baseline, RRs were more frequently negative for AMCV subtypes, especially for IgA (68 %), compared to NRRs (31 %). Being AMCV IgA-negative at baseline indicated a good treatment response to RTX (negative predictive value = 0.86). Co-existence of AMCV IgA and IgG with stable titers upon treatment were associated with poorer responses to RTX. Furthermore, reductions of AMCV IgA levels upon RTX correlated with the improvement of 28-joint Disease Activity Score (DAS28). In comparison, subtypes of RF and ACCP were not of additional value for prediction of RTX response. Conclusions Restrictive IgG seropositivity against MCV with treatment-associated decline in fine reactivity and titers was predictive for response to RTX. Double-positivity for AMCV IgG and IgA was associated with failure to respond to BCDT, suggesting a pathogenetic and less sensitive IgA-producing B-cell subset in NRRs. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0717-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luisa Lindenberg
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine, Chariteplatz 1, 10117, Berlin, Germany.
| | - Lydia Spengler
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine, Chariteplatz 1, 10117, Berlin, Germany.
| | - Holger Bang
- Orgentec Diagnostika GmbH, Carl-Zeiss-St. 49, Mainz, 55129, Germany.
| | - Thomas Dorner
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine, Chariteplatz 1, 10117, Berlin, Germany.
| | - Aleksej L Maslyanskiy
- Federal Almazov, Medical Research Centre, Akkuratova street 2, St. Petersburg, 197341, Russia.
| | - Sergey V Lapin
- St. Petersburg State Pavlov Medical University, Center for Molecular Medicine, ul. Lva Tolstogo 6-8, St. Petersburg, 197022, Russia.
| | - Elena I Ilivanova
- Rheumatology Department, Leningrad Regional Clinical Hospital, Lunacharskogo pr. 49, St. Petersburg, 194291, Russia.
| | - Lorena Martinez-Gamboa
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine, Chariteplatz 1, 10117, Berlin, Germany.
| | - Hans Bastian
- Immanuel Hospital, Clinic of Rheumatology, Lindenberger Weg 19, Berlin-Buch, 13125, Germany.
| | - Esther Wittenborn
- Roche Pharma, Rheumatology, Emil-Barell-St 1, Grenzach-Wyhlen, 79639, Germany.
| | - Karl Egerer
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine, Chariteplatz 1, 10117, Berlin, Germany. .,Labor-Berlin GmbH, Sylter St 2, Berlin, 13353, Germany.
| | - Gerd-R Burmester
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine, Chariteplatz 1, 10117, Berlin, Germany.
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine, Chariteplatz 1, 10117, Berlin, Germany.
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Sakthiswary R, Shaharir SS, Mohd Said MS, Asrul AW, Shahril NS. IgA rheumatoid factor as a serological predictor of poor response to tumour necrosis factor α inhibitors in rheumatoid arthritis. Int J Rheum Dis 2014; 17:872-7. [DOI: 10.1111/1756-185x.12443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Rajalingham Sakthiswary
- Department of Medicine; Universiti Kebangsaan Malaysia Medical Centre; Kuala Lumpur Malaysia
| | - Syahrul S. Shaharir
- Department of Medicine; Universiti Kebangsaan Malaysia Medical Centre; Kuala Lumpur Malaysia
| | - Mohd S. Mohd Said
- Department of Medicine; Universiti Kebangsaan Malaysia Medical Centre; Kuala Lumpur Malaysia
| | - Abdul W. Asrul
- Department of Microbiology and Immunology; Universiti Kebangsaan Malaysia Medical Centre; Kuala Lumpur Malaysia
| | - Nor S. Shahril
- Department of Medicine; Putrajaya Hospital; Kuala Lumpur Malaysia
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Abstract
The treatment of rheumatoid arthritis (RA) has changed dramatically in the past decade as advancements in the understanding of the pathobiology of the disease have led to novel therapeutic agents. The recognition that early diagnosis and treatment leads to improvements in morbidity and mortality has altered the therapeutic strategy such that early therapy is now considered the standard of care. This review focuses on the challenges in making the diagnosis of early RA, including a broad differential diagnosis for inflammatory polyarthritis, poor performance of the standard classification criteria, difficulty in clinical assessment of synovitis, absence of absolute laboratory tests, inability of conventional radiography to detect bony changes early, and barriers to rheumatology care. Additionally, the pathogenesis of RA is highlighted, with particular emphasis on cytokine biology as it relates to therapeutic regimens. Relevant clinical trials in early RA are reviewed and discussed, including trials of combination disease-modifying antirheumatic drugs and biological therapy. The role of induction therapy as a novel therapeutic approach is highlighted. The search for predictors of response is reviewed and the external validity of the trials is analysed. Finally, the trials in early RA therapy suggest that swift intervention with combinations of medications is required for patients with severe RA. However, further research is needed to determine which regimen is appropriate for the individual patient with RA.
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Affiliation(s)
- Amy C Cannella
- University of Nebraska Medical Center, Omaha, Nebraska 68198-3025, USA.
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8
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Lindqvist E, Eberhardt K, Bendtzen K, Heinegård D, Saxne T. Prognostic laboratory markers of joint damage in rheumatoid arthritis. Ann Rheum Dis 2004; 64:196-201. [PMID: 15458956 PMCID: PMC1755350 DOI: 10.1136/ard.2003.019992] [Citation(s) in RCA: 225] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate whether determination of a set of laboratory markers at baseline provides prognostic information on joint damage in hands and feet in rheumatoid arthritis. METHODS 183 patients with early rheumatoid arthritis included in a prospective study were examined. Radiographic changes in hands and feet at 5 and 10 years after inclusion were evaluated (Larsen). The markers analysed were: erythrocyte sedimentation rate (ESR); HLA-DRB alleles typed by restriction fragment length polymorphism; and C reactive protein, cartilage oligomeric matrix protein (COMP), rheumatoid factor (RF) (IgG, IgA, and IgM subtypes), antibodies against cyclic citrullinated peptide (anti-CCP), and antibodies against interleukin 1alpha (anti-IL1alpha), analysed by immunoassays. Multiple linear regression with backward elimination was used to determine the prognostic value of the variables. RESULTS 117/176 patients were positive for IgG RF, 138/176 for IgA RF, 139/176 for IgM RF, 140/176 for anti-CCP, and 40/182 for anti-IL1alpha. After five years, ESR, the presence of IgA RF, serum COMP, and the presence of anti-CCP were significantly associated with more severe joint damage, and the presence of anti-IL1alpha with less severe joint damage. Baseline C reactive protein and anti-CCP predicted radiographic outcome after 10 years. A stronger prediction was obtained by combining the prognostic factors. CONCLUSIONS Early determination of anti-CCP, IgA RF, anti-IL-1alpha, ESR, C reactive protein, and COMP predicted the development of joint damage in hands and feet in this cohort. A combination of these measures reflecting different aspects of the disease process should be useful for evaluating prognosis in individual patients with early rheumatoid arthritis.
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Affiliation(s)
- E Lindqvist
- Department of Rheumatology, Lund University Hospital, S-221 85 Lund, Sweden.
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9
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Varbanova BB, Baleva M, Nikolov K, Mihailova D. Prevalence of IgM-, IgA- and IgG-rheumatoid factors in seronegative polyarticular disease compared to pauciarticular disease in juvenile chronic arthritis as measured by ELISA. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2000; 455:61-8. [PMID: 10599324 DOI: 10.1007/978-1-4615-4857-7_9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To determine the prevalence of the rheumatoid factor isotypes measured by enzyme-linked immunosorbent assay (ELISA) in polyarticular and pauciarticular juvenile chronic arthritis (JCA), and evaluate the diagnostic test qualities. PATIENTS AND METHODS 53 patients with JCA (20 with seronegative polyarticular disease at onset, 21 with pauciarticular onset and course of disease and 12 with extended pauciarticular disease), as well as 125 control children (58 healthy controls and 67 patients with other diseases) were tested. ELISA for the detection of IgM-, IgA- and IgG-isotypes of RFs was used. The diagnostic characteristics of the tests were evaluated by means of clinical epidemiology methods. RESULTS The prevalence of the ELISA for IgG-, IgA-, and IgM-RF for JCA patients vs all controls at optimal cut-off titres was 13%, 29%, and 32%, respectively. The test for IgG-RF was established to be of no significance. IgA-RF had higher prevalence in the polyarticular and extended pauciarticular form, 40% and 33%, respectively. IgM-RF showed a prevalence of 55% for the polyarticular and 42% for the extended pauciarticular form. No significant prevalence has been found in the pauciarticular form. CONCLUSION Our results indicate that ELISA for IgG-RF is of no diagnostic value for JCA. The ELISAs for IgM- and IgA-RFs demonstrated a diagnostic significance for the polyarticular and extended pauciarticular form. Juvenile chronic arthritis (JCA) is a heterogeneous disease which encompasses different forms defined by the type of onset. There is evidence, supported by immunogenetic studies that the various subgroups may represent distinct disease entities [1, 2]. Numerous immunological abnormalities have been detected in JCA, but the most characteristic serological findings are ANA and IgM-rheumatoid factor, thought to be useful in the classification of patients and their management. Antinuclear antibodies are universal in JCA, most commonly found in children with early onset pauciarthritis and late onset seropositive polyarthritis [1, 2, 3]. In contrast, the IgM-rheumatoid factor, measured by conventional agglutination techniques, is a hallmark only of polyarthritis with late onset resembling adult rheumatoid arthritis. This group of patients with "seropositive" disease represents less than 20% of all JCA children. Of those patients with "seronegative" disease 20-30% have a systemic onset and the remainder have either a pauciarticular or polyarticular form [2, 3]. Following the introduction of more sensitive techniques, it has already been established that rheumatoid arthritis (RA) patients' sera contain not only the "classical" 19S IgM-RF, but also other isotypes of the rheumatoid factor (RF). A number of studies have emphasized the presence of IgG-, IgA-, IgM- and even IgE- RF in patients with "seronegative" RA [4, 5, 6]. The aim of this study is to determine the prevalence of IgG, IgM and IgA RFs and to attempt at evaluating the diagnostic and prognostic qualities of the ELISA-tests for rheumatoid factor isotypes in polyarticular and pauciarticular forms at onset of JCA.
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Affiliation(s)
- B B Varbanova
- Department of Paediatrics, Varna Medical University, Bulgaria
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10
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Williams DG, Moyes SP, Mageed RA. Rheumatoid factor isotype switch and somatic mutation variants within rheumatoid arthritis synovium. Immunology 1999; 98:123-36. [PMID: 10469243 PMCID: PMC2326907 DOI: 10.1046/j.1365-2567.1999.00841.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The presence of clonally-related B-lymphocyte aggregates within synovial lining tisue of rheumatoid arthritis (RA) patients suggests a germinal centre-like reaction, which may hold implications for disease pathogenesis and the causes of chronic inflammation. We studied 250 rheumatoid factor (RF) heavy-chain sequences cloned from the synovium of three patients with RA, to determine whether they undergo both somatic mutation and isotype switching consistent with this hypothesis. Size analysis of immunoglobulin heavy-chain cDNAs from synovial RF+ B cells revealed oligoclonal RF+ populations and identically-sized VH-D-JH transcripts of different immunoglobulin isotypes. Sequencing of individual inserts selected from cloned immunoglobulin heavy-chain cDNAs demonstrated a clonal relationship between immunoglobulin M (IgM) RF and IgA RF, suggesting that this isotype switch occurred in synovium. Furthermore, most somatic mutations were found to have occurred after this isotype switch. This finding suggests that the RA synovial microenvironment sustains somatic mutation and isotype switching in RF-specific B lymphocytes akin to secondary lymphoid organs.
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Wolfe F, Sharp JT. Radiographic outcome of recent-onset rheumatoid arthritis: a 19-year study of radiographic progression. ARTHRITIS AND RHEUMATISM 1998; 41:1571-82. [PMID: 9751089 DOI: 10.1002/1529-0131(199809)41:9<1571::aid-art7>3.0.co;2-r] [Citation(s) in RCA: 199] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To describe the longitudinal radiographic course of rheumatoid arthritis (RA), and to identify and quantitate predictors of radiographic progression. METHODS This prospective, longitudinal study of radiographic progression and clinical predictors of RA involved 256 patients with RA who were seen within the first 2 years of disease (mean 0.77 years) and were followed up for up to 19 years. Participants underwent a total of 6,278 clinical assessments (mean 24.5) and 934 paired radiographs (mean 3.1, range 2-6). Clinical assessments at every visit included determination of the erythrocyte sedimentation rate (ESR), grip strength, pain scores, tender joint counts, and anxiety and depression measurements. Regression analyses utilized time-integrated predictors. RESULTS Overall, radiographic progression rates, as measured by the summary Sharp scores, appeared constant over the course of RA. The strongest correlate of progression was the time-integrated ESR (rho=0.53). This association grew stronger with time. At 0-5 years, 5-10 years, 10-15 years, and 15-20 years, correlations were 0.40, 0.50, 0.65, and 0.74, respectively, and for the period 10-20 years, the correlation was 0.67. In multivariate models, the mean ESR, mean grip strength, rheumatoid factor positivity, and tender joint count were independent predictors of radiographic progression. CONCLUSION Radiographic damage occurs at a constant rate in RA, and is not greater early in RA or reduced later in the course of the illness. Acute-phase reactants are, by far, the strongest determinants of progression.
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Affiliation(s)
- F Wolfe
- Arthritis Research Center and University of Kansas School of Medicine, Wichita, USA
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12
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Jónsson T, Thorsteinsson H, Arinbjarnarson S, Thorsteinsson J, Valdimarsson H. Clinical implications of IgA rheumatoid factor subclasses. Ann Rheum Dis 1995; 54:578-81. [PMID: 7668901 PMCID: PMC1009938 DOI: 10.1136/ard.54.7.578] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To evaluate the diagnostic and pathogenetic significance of IgA rheumatoid factor (RF) subclasses in rheumatoid arthritis (RA). METHODS Rheumatoid factors of the IgA class and IgA1 and IgA2 subclasses were measured by enzyme linked immunosorbent assay in 58 patients with RA, 31 patients with other rheumatic diseases, 30 non-rheumatic individuals with increased concentrations of IgA RF, and in 100 randomly selected healthy controls. RESULTS Using a 95% cut off for the controls, 55% of the RA patients had increased total IgA RF, 64% IgA1 RF, and 60% IgA2 RF. RA patients with extraarticular manifestations more often had increased concentrations of IgA RF and both subclasses than patients without such manifestations (p < or = 0.01). Nearly all (31/32) RA patients with increased IgA RF had increases in both IgA RF subclasses, compared with 67% (20/30 of nonrheumatic symptom free individuals with increased IgA RF (p = 0.002). CONCLUSION Increased concentrations of the IgA2 RF subclass appears to be more specific for RA than increased IgA1 RF. Measurement of IgA RF subclasses may be clinically useful.
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Affiliation(s)
- T Jónsson
- Department of Immunology, National University Hospital, Reykjavík, Iceland
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13
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Moore S, Ruska K, Peters L, Olsen NJ. Associations of IgA and IgA-rheumatoid factor with disease features in patients with rheumatoid arthritis. Immunol Invest 1994; 23:355-65. [PMID: 7851956 DOI: 10.3109/08820139409066831] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In previous studies we have shown that levels of IgM-rheumatoid factor (RF) in plasma and peripheral blood mononuclear cell supernatants are correlated with disease activity and response to second-line therapy in patients with rheumatoid arthritis (RA). The present studies were designed to examine whether IgA-RF levels are also correlated with clinical features of this disease. Two groups of RA patients were studied. Group I consisted of 87 patients in whom extensive clinical data had been collected. Group II included nine patients beginning treatment with gold or methotrexate who were studied during the first year of therapy. Measurement of IgM, IgA, IgM-RF and IgA-RF in culture supernatants and plasma was done by an ELISA method. These data were examined for correlations with clinical and laboratory features. Levels of IgA-RF in supernatants and plasma were found not to be correlated with disease features in the cross-sectional analysis of Group I patients, while IgM-RF and total IgA levels did show significant clinical correlation. Treatment of Group II patients with gold or methotrexate was associated with significant decreases in plasma levels of total IgA and IgM-RF as well as a small but statistically significant decrease in plasma IgA-RF. Plasma levels of total IgM were not altered during therapy. These findings suggest that production of IgA but not IgA-RF is correlated with disease status in patients with RA.
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Affiliation(s)
- S Moore
- Department of Medicine, Vanderbilt University, Nashville, TN
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14
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Quinn C, Mulpeter K, Casey EB, Feighery CF. Changes in levels of IgM RF and alpha 2 PAG correlate with increased disease activity in rheumatoid arthritis during the puerperium. Scand J Rheumatol 1993; 22:273-9. [PMID: 7505481 DOI: 10.3109/03009749309095138] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In this prospective study of 24 pregnant patients with rheumatoid arthritis, quiescent disease activity in 21 patients (88%) during gestation was followed by more active disease in the puerperium in 19 patients (79%). Increased disease activity was reflected in a deterioration in manual dexterity and this was found to correlate with a post-partum rise in IgM rheumatoid factor (IgM RF) (r = 0.86) and a post-partum decline in pregnancy associated alpha-2 glycoprotein (PAG) (r = 0.44). The increase in IgM RF also correlated with increased disease activity measured by a visual analogue scale (r = 0.44). Changes in IgA RF were not observed. These results suggest that PAG and IgM RF could contribute to the modulation and pathogenesis of rheumatoid arthritis during pregnancy.
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Affiliation(s)
- C Quinn
- Department of Immunology, St. James's Hospital and Trinity College, Dublin, Ireland
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15
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Otten HG, Daha MR, van der Maarl MG, Hoogendoorn LI, Beem EM, de Rooy HH, Breedveld FC. IgA rheumatoid factor in mucosal fluids and serum of patients with rheumatoid arthritis: immunological aspects and clinical significance. Clin Exp Immunol 1992; 90:256-9. [PMID: 1424283 PMCID: PMC1554607 DOI: 10.1111/j.1365-2249.1992.tb07938.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In order to gain insight into the production and clinical significance of IgA rheumatoid factor (IgA-RF) in mucosal fluids of patients with rheumatoid arthritis (RA), we examined tear fluid, saliva and serum from 80 patients with RA. Significant correlations were found between IgA-RF levels in tear fluid and saliva (P = 0.002, r = 0.57), saliva and serum (P < 0.001, r = 0.79), and serum and tear fluid (P < 0.001, r = 0.31). No significant correlations were found between total IgA levels in these fluids. Comparison between circulating and mucosal IgA-RF levels after correction for total IgA, revealed that mucosal IgA-RF levels are on average 2.5 times higher than circulating IgA-RF levels. Analysis of IgA-RF specificity showed that lacrimal and salivary IgA-RF reactivity with various IgG subclasses is similar and differs from serum IgA-RF specificity. These results indicate local production of IgA-RF in salivary and lacrimal glands and support the view of a common origin of IgA-RF producing B cells present in mucosal tissues. Mucosal and circulating levels of IgA and IgA-RF were not associated with tests that quantify tear fluid production. This indicates that mucosal and circulating levels of IgA and IgA-RF in patients with RA cannot be regarded as markers for the development of secondary Sjögren's syndrome.
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Affiliation(s)
- H G Otten
- Department of Rheumatology, University Hospital Leiden, The Netherlands
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Mierau R, Gause A, Küppers R, Michels M, Mageed RA, Jefferis R, Genth E. A human monoclonal IgA rheumatoid factor using the VkIV light chain gene. Rheumatol Int 1992; 12:23-31. [PMID: 1598498 DOI: 10.1007/bf00246873] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A human hybridoma stably secreting IgA rheumatoid factor (RF) was produced by cell hybridization with peripheral blood lymphocytes of a patient with rheumatoid arthritis. The RF was of the IgA1 isotype with kappa-light chains and was useful for standardization or specificity controls in class-specific RF assays. RF activity was detected only when the IgA molecular were in a polymeric state, and could be measured by enzyme linked immunosorbent assay as well as in conventional agglutination based tests. The RF had the modified Ga fine specificity described previously for several RFs and for protein A. The immunoglobulin V genes used were isolated and sequenced. The light chain was encoded by the VkIV gene rearranged to Jk2; compared to the published VkIV germ line gene there was 90% nucleotide homology. The heavy chain gene used belonged to the VHI family and was rearranged to JH4. Comparisons with published sequences revealed 90% homology with the recently characterized VH gene expressed by RF-TS3, a rheumatoid synovia RF hybridoma.
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Affiliation(s)
- R Mierau
- Rheumaklinik Aachen, Federal Republic of Germany
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