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Carroll GJ, Makin K, Garnsey M, Bulsara M, Carroll BV, Curtin SM, Allan EM, McLean-Tooke A, Bundell C, Kemp ML, Deshpande P, Ihdayhid D, Coleman S, Easter T, Triplett J, Disteldorf T, Marsden CH, Lucas M. Undetectable Mannose Binding Lectin and Corticosteroids Increase Serious Infection Risk in Rheumatoid Arthritis. J Allergy Clin Immunol Pract 2017. [PMID: 28634103 DOI: 10.1016/j.jaip.2017.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infection is the leading cause of death in rheumatoid arthritis (RA). Corticosteroid (CS) use is a known and important risk factor for serious infections (SIs). Mannose binding lectin (MBL) is a genetically determined component of the innate immune system implicated in neonatal infections. OBJECTIVE Our aim was to determine whether MBL deficiency is a risk factor for SIs in RA and to compare it with CS use and also synthetic and biologic disease-modifying antirheumatic drug (DMARD) therapy. METHODS Data on 228 patients with RA were collected for up to 7 years (median = 5.9 years). Serum MBL concentrations were determined in all patients receiving synthetic (n = 96) or biologic (n = 132) DMARD therapy. RESULTS High rates of SIs were observed in RA irrespective of treatment (17%). Similar rates of SIs were observed in synthetic and biologic DMARD users. The rates of single and multiple SIs were similar, irrespective of the use of a biologic agent. Undetectable MBL (<56 ng/mL) concentrations and maintenance prednisolone at 10 mg per day or higher were associated with an increased risk for an SI, with incident risk ratio of 4.67 (P = .001) and 4.70 (P < .001), respectively. CONCLUSIONS Undetectable MBL and prednisolone confer a high risk for an SI. The use of biologic DMARDs did not confer substantial SI risk in this observational study. MBL deficiency is hitherto an unrecognized risk factor for an SI in RA.
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Affiliation(s)
- Graeme J Carroll
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia; Department of Rheumatology, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia; ArthroCare, Mt Lawley, Western Australia, Australia.
| | - Krista Makin
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Maxine Garnsey
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Max Bulsara
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Bronwyn V Carroll
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Shona M Curtin
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Erin M Allan
- ArthroCare, Mt Lawley, Western Australia, Australia
| | - Andrew McLean-Tooke
- Department of Clinical Immunology, Pathwest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Christine Bundell
- Department of Clinical Immunology, Pathwest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Monica L Kemp
- Department of Clinical Immunology, Pathwest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Pooja Deshpande
- School of Medicine, University of Western Australia, Human Anatomy and Biology, Perth, Western Australia, Australia
| | - Dana Ihdayhid
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | | | - Tracie Easter
- Department of Clinical Immunology, Pathwest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - James Triplett
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Timothy Disteldorf
- School of Medicine, University of Western Australia, Human Anatomy and Biology, Perth, Western Australia, Australia
| | - C Helen Marsden
- Department of Rheumatology, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Michaela Lucas
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Department of Clinical Immunology, Pathwest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia; University of Western Australia, School of Medicine and Pharmacology, Pathology and Laboratory Medicine, Perth, Western Australia, Australia
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Abstract
Systems biology is uniquely situated at the interface of computing, mathematics, engineering and the biological sciences. This positioning creates unique challenges and opportunities over other interdisciplinary studies when developing academic curricula. Integrative systems biology attempts to span the field from observation to innovation, and thus requires successful students to gain skills from mining to manipulation. The authors outline examples of graduate program structures, as well as curricular aspects and assessment metrics that can be customised around the environmental niche of the academic institution towards the formalisation of effective educational opportunities in systems biology. Some of this material was presented at the 2009 Foundations of Systems Biology in Engineering (FOSBE 2009) Conference in Denver, August 2009.
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Affiliation(s)
- E O Voit
- Georgia Institute of Technology and Emory University, Integrative BioSystems Institute and Wallace H. Coulter Department of Biomedical Engineering, Atlanta, USA
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Abstract
BACKGROUND The importance of antinucleolar antibodies seen by indirect immunofluorescence on HEp-2 cells, although associated with systemic sclerosis (SSc), in unselected patients is unknown. AIMS To determine the true clinical significance of antinucleolar antibodies in an unselected patient population. METHODS Antinucleolar antibody (ANoA) positive samples were identified in the immunology laboratory during routine autoimmune screening tests; case notes were reviewed using a standard proforma. RESULTS 104 patients with ANoA were identified and ANoA+ samples were subclassified into homogeneous, clumpy and speckled antinucleolar types. SSc was evident in only two (1.8%) patients. Other connective tissue diseases were identified in 33 patients (32%); 22 patients (21%) had evidence of various malignancies. Both disordered liver function and anaemia were seen in 22 patients and were the commonest laboratory abnormalities. CONCLUSIONS Neither the presence nor subtype of ANoA is specific for systemic sclerosis. Laboratory comments appended to results should reflect this fact.
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Affiliation(s)
- S Khan
- Path Links Immunology, Scunthorpe General Hospital, Scunthorpe, UK.
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