CONCISE REPORT Blockade of tumour necrosis factor a significantly alters the serum level of IgG- and IgA-rheumatoid factor in patients with rheumatoid arthritis

Objective: To determine the effect on the humoral immune system of long term treatment of patients with RA with etanercept. Methods: 12 consecutive patients with seropositive RA treated with etanercept were studied and followed up for 9 months. Clinical efficacy of treatment was evaluated using the 28 joint count Disease Activity Score (DAS28). Serum samples were collected at baseline and after 9 months and serum immunoglobulin, RF isotypes, and anti-cyclic citrullinated peptide (aCCP), antinuclear, nucleosome, and dsDNA antibodies determined. For comparison 7 patients with seropositive RA treated with adalimumab were studied. Results: DAS28 decreased significantly after the first month and then was constant for the whole study (5.7 (0.3) v 3.8 (0.2), p(0.000). Serum IgA-RF and IgG-RF increased significantly after 9 months’ etanercept treatment (mean (SEM) IgA-RF rose from 19.5 (4.8) to 30.5 (5.9) IU/ml, p(0.01; IgG-RF from 20.6 (8.1) to 33.8 (11.5) IU/ml, p(0.04). Serum levels of total immunoglobulin and specific autoantibodies remained unchanged during the study. In patients treated with adalimumab, no significant changes in serum levels of RF isotypes and aCCP antibodies were seen. Conclusion: Etanercept, although effective in treating the clinical symptoms of RA, seems to have a pivotal effect on RFproducing B cells either directly or indirectly.