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Ann Rheum Dis 2002;61:358-361 doi:10.1136/ard.61.4.358
  • Concise report

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

  1. G Ferraccioli,
  2. F Mecchia,
  3. E Di Poi,
  4. M Fabris
  1. Chair and Division of Rheumatology, DPMSC, Udine University Medical Centre, University of Udine, 33100 Udine, Italy
  1. Correspondence to:
    Professor G Ferraccioli, Chair and Division of Rheumatology, DPMSC, Udine University Medical Centre, University of Udine, 33100 Udine, Italy;
    gf.ferraccioli{at}med.uniud.it
  • Accepted 10 September 2001

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 α is blocked. Eradication of the infections leads to a rapid decrease of ACA-IgG and of anti-DNA levels.

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