Extended report
Increased IgA rheumatoid factor and VH1 associated
cross reactive idiotype expression in patients with Lyme arthritis and
neuroborreliosis
John S Axforda, David H E Reesb, Rizgar A Mageedc, Paul Wordsworthd, Azita Alavia, Allen C Steeree
a Academic Unit for
Musculoskeletal Disease, St George's Hospital Medical School, London, b Department of
Rheumatology, Hereford County Hospital, c Department of Rheumatology, The Kennedy
Institute of Rheumatology, London, d Musculoskeletal
Research Unit, The Wellcome Trust Centre for Human Genetics, London, e Tufts University School of
Medicine, New England Medical Center, Boston, USA
Correspondence to: Dr J S Axford, Academic Unit for Musculoskeletal Disease, St George's Hospital Medical School, Cranmer Terrace, London SW17 ORE.
Accepted for publication 11 August 1999
OBJECTIVE
To
investigate whether autoreactive mechanisms occur in Lyme disease (LD)
by determining IgA, IgG and IgM rheumatoid factor (RF) concentrations
and RF associated cross reactive idiotype (CRI) expression in the serum
of LD patients, with comparison to patients with rheumatoid arthritis (RA).
METHODSThe RF isotype
profiles were determined in 59 patients with LD; erythema migrans (EM)
(n=19), neuroborreliosis (NB) (n=20) and Lyme arthritis (LA) (n=20).
Mouse monoclonal antibodies (mAbs) G6 and G8 (VH1 gene
associated), D12 (VH3 gene associated) and C7
(V
III gene associated) were then used to determine the RF associated CRI expression on IgM antibodies in 16 of these LD
patients (eight seropositive for RF); (EM (n=3), NB (n=6), LA (n=7)).
RESULTSSeven (18%)
patients with either NB or LA had increased concentrations of IgA RF
compared with none with EM. Significant differences in the number of
patients with raised concentrations of IgG RF or IgM RF were not found
between the LD patient groups. Five (3NB, 1LA and 1 EM) (31%) and
three (2NB and 1LA) (19%) of LD patients had raised concentrations of
the CRIs recognised by mAbs G6 and G8, respectively. These CRIs were
detected in LD sera both with and without raised concentrations of RF
and were not demonstrated on anti-Borrelia burgdorferi antibodies using
ELISA. No LD sera tested had raised concentrations of the determinants
recognised by mAbs C7 or D12.
CONCLUSIONSignificantly
raised concentrations of IgA RF and increased use of VH1
germline gene associated CRIs are found on IgM antibodies in the serum
of LD patients. These data indicate the recruitment of autoreactive B
lymphocytes in some patients with the later stages of LD.
© 1999 by Annals of the Rheumatic Diseases
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