Immunoglobulin A antibodies against phosphorylcholine in rheumatoid arthritis patients and its association with clinical outcomes
Abstract: Rheumatoid arthritis (RA) is an autoimmune disorder, primarily affecting the joints in wrist and hands. RA develops slowly and can cause physical disabilities which may lead to extra-articular manifestations, damaging other parts of the body such as heart and blood vessels. RA patients have an elevated chance of developing atherosclerosis or cardiovascular disease (CVD). This study investigated the role of natural IgA (immunoglobulin A) antibodies against phosphorylcholine (PC) in RA patients and its association with clinical outcomes. IgA anti-PC levels were measured at baseline (day 1) and after 24 weeks by following an optimized indirect ELISA protocol in 682 patients with early rheumatoid arthritis. All patients followed the conventional treatment by receiving methotrexate. To this was included: Arm 1 (Active conventional treatment): prednisolone, or sulphasalazine, hydroxychloroquine. Arm 2 included certolizumab, Arm 3 included abatacept and Arm 4 included tocilizumab. Disease activity was determined by DAS28. After 24 weeks, the mean value of DAS28 was significantly reduced in patients who reached remission (DAS28<2.6), p= 0.0001. Patients who achieved remission in week 24 did not show any significant difference with non-remission (DAS>2.6) patients in IgA anti-PC values at baseline. However, there may be differences in subgroups of patients with high IgA anti-PC at baseline, and also in the different treatment arms, which will be explored in further studies. The treatments with Arm 1, 2, 3 and its association with IgA anti-PC did not show any significant difference, except the treatment with Tocilizumab (Arm 4) and methotrexate which showed a significantly lower level of IgA anti-PC level after 24 weeks, p= 0.0143. One interesting possibility is that this treatment could increase the risk of CVD in the long run. This present study offers new insights into the role of IgA anti-PC in the development of RA with different treatments. IgA anti-PC decreased during treatment, in the whole group. The results indicate that IgA anti-PC might be a novel biomarker for RA as the association between IgA anti-PC and disease activity in RA was elucidated to some extent. Some treatments decreased the levels of IgA anti-PC, which may have a negative effect on RA and may lead to a higher risk of developing atherosclerosis and CVD.
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