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Low mannose binding lectin predicts poor prognosis in patients with early rheumatoid arthritis. A prospective study
S Saevarsdottir1, T Vikingsdottir, A Vikingsson
1Department of Immunology, Landspitalinn University Hospital, Reykjavik, Iceland.
Objective:
To determine whether low mannose binding lectin (MBL) is associated with poor prognosis in rheumatoid arthritis (RA) and whether patients with RA have increased frequency of MBL deficiency.
Methods:
Patients with recent onset symmetric polyarthritis (< 1 year, median 3 mo) were recruited if they had not been treated longer than 2 weeks with disease modifying drugs. They were reevaluated after 6 months and their disease activity and progression were correlated with their MBL concentration, rheumatoid factor (RF) isotypes, and C-reactive protein (CRP). Sixty-three female patients with advanced RA were also analyzed.
Results:
Sixty-five patients with early arthritis fulfilled American College of Rheumatology criteria for RA and 52 were followed for 6 months or longer. Low MBL was associated with raised RF, IgA RF in particular (p = 0.02). and also with a combined elevation of IgM and IgA RF (p = 0.035). Patients with low MBL (lowest 25th percentile) showed less improvement after 6 months of treatment than patients in the highest MBL quartile. This applied to the Thompson joint score (p = 0.03) and grip strength (p = 0.004). Low MBL was also significantly associated with radiological joint erosions at recruitment and at 6 month followup (p = 0.039); and the group with advanced RA also showed a significant association between low MBL concentration and radiological damage (p = 0.036). However. neither patient group had increased frequency of MBL deficiency compared to healthy controls.
Conclusion:
Low MBL predicts poor prognosis in patients with early RA.
Insights
Low mannose binding lectin (MBL) levels predict a poorer prognosis in rheumatoid arthritis (RA) patients, indicating worse disease progression and joint damage. MBL deficiency was not more frequent in RA patients than controls.
Area of Science:
- Immunology
- Rheumatology
Background:
- Mannose binding lectin (MBL) plays a role in innate immunity.
- MBL deficiency may influence autoimmune disease development and progression.
Purpose of the Study:
- To investigate the association between low MBL levels and prognosis in rheumatoid arthritis (RA).
- To determine if RA patients exhibit a higher frequency of MBL deficiency.
Main Methods:
- Early arthritis patients (<1 year symptom duration) were assessed for MBL concentration, rheumatoid factor (RF) isotypes, and C-reactive protein (CRP).
- Disease activity and progression (joint scores, grip strength, radiological erosions) were evaluated after 6 months.
- Advanced RA patients were also analyzed for MBL association with radiological damage.
Main Results:
- Low MBL levels correlated with elevated RF, particularly IgA RF, and combined IgM/IgA RF.
- Patients with low MBL showed less improvement in joint scores and grip strength over 6 months.
- Low MBL was significantly associated with radiological joint erosions at baseline and follow-up in early RA, and with radiological damage in advanced RA.
- No increased frequency of MBL deficiency was observed in RA patients compared to healthy controls.
Conclusions:
- Low MBL concentration is a predictor of poor prognosis in early rheumatoid arthritis.
- Low MBL is linked to increased disease activity, poorer treatment response, and greater radiological damage in RA.