Anticardiolipin antibodies in rheumatoid patients treated with etanercept or conventional combination therapy: direct and indirect evidence for a possible association with infections.

Abstract

OBJECTIVE:

To assess the occurrence of anticardiolipin antibodies (ACA) (as well as of anti-DNA antibodies) in patients with rheumatoid arthritis treated with etanercept or combination therapy.

METHODS:

Eight patients treated with etanercept 25 mg twice weekly were studied for a period of 85 weeks. A control group of 39 patients with rheumatoid arthritis undergoing combination treatment (methotrexate (MTX) + cyclosporin A or MTX + chloroquine) were studied for the same period of time. The occurrence of anticardiolipin antibodies (ACA-IgG) and anti-DNA was examined, together with the possible occurrence of infections due to bacteria capable of inducing B cell activation.

RESULTS:

In 5/8 patients receiving etanercept an increase of ACA-IgG was seen, while anti-DNA became positive in 3/8 patients. A nasal or bronchial infection due to Staphylococcus aureus (Staph aureus) or a urinary tract infection due to E coli, occurred in all five cases. Antibiotic treatment produced a return to normal of ACA-IgG, and also of anti-DNA, in all cases except one. The infectious agent was eradicated in all subjects but one. In the control group Staph aureus was found in the nasal swab in 10/39 subjects; ACA-IgM (followed by ACA-IgG) appeared at the same time as infection occurred in 6/10, while no infection related to the increased ACA-IgM was recorded in the other four.

CONCLUSIONS:

Bacterial DNA, especially that enriched in CpG motifs, is a powerful immunostimulant that may, in some cases, lead to ACA or anti-DNA positivity, once tumour necrosis factor alpha is blocked. Eradication of the infections leads to a rapid decrease of ACA-IgG and of anti-DNA levels.

• Authors: G Ferraccioli, F Mecchia, E Di Poi, M Fabris
• Journal: Annals of the rheumatic diseases (Ann Rheum Dis) Vol. 61 Issue 4 Pg. 358-61 (Apr 2002) ISSN: 0003-4967 [Print] England
• PMID: 11874843 (Publication Type: Journal Article)

Chemical References

• Antibodies, Anticardiolipin
• Antibodies, Antinuclear
• Antirheumatic Agents
• Drug Combinations
• Immunoglobulin G
• Immunoglobulin M
• Receptors, Tumor Necrosis Factor
• Cyclosporine
• Chloroquine
• Etanercept
• Methotrexate

Topics

• Adolescent
• Adult
• Aged
• Antibodies, Anticardiolipin (analysis)
• Antibodies, Antinuclear (analysis)
• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (drug therapy, immunology)
• Child
• Child, Preschool
• Chloroquine (therapeutic use)
• Cyclosporine (therapeutic use)
• Drug Combinations
• Etanercept
• Humans
• Immunoglobulin G (analysis, therapeutic use)
• Immunoglobulin M (analysis)
• Infant
• Infant, Newborn
• Methotrexate (therapeutic use)
• Middle Aged
• Receptors, Tumor Necrosis Factor (therapeutic use)
• Staphylococcal Infections (drug therapy, immunology)
• Staphylococcus aureus