Anticardiolipin antibodies in rheumatoid patients treated with etanercept

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Ann Rheum Dis 2002 Apr;61(4):358-61

Anticardiolipin antibodies in rheumatoid patients treated with

etanercept or conventional combination therapy: direct and indirect

evidence for a possible association with infections.

Ferraccioli G, Mecchia F, Di Poi E, Fabris M.

Chair and Division of Rheumatology, DPMSC, Udine University Medical

Centre, University of Udine, 33100 Udine, Italy.

gf.ferraccioli@...

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.

PMID: 11874843