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Undetectable Mannose Binding Lectin and Corticosteroids Increase Serious Infection Risk in Rheumatoid Arthritis.

Graeme J Carroll1, Krista Makin2, Maxine Garnsey3

  • 1School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia; Department of Rheumatology, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia; ArthroCare, Mt Lawley, Western Australia, Australia.

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|June 22, 2017
PubMed
Summary
This summary is machine-generated.

Mannose-binding lectin (MBL) deficiency and corticosteroid use are significant risk factors for serious infections (SIs) in rheumatoid arthritis (RA) patients. Biologic DMARDs did not increase SI risk in this study.

Keywords:
Immune systemMannose binding lectinRheumatoid arthritisRisk factorSerious infection

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Area of Science:

  • Rheumatology
  • Immunology
  • Infectious Diseases

Background:

  • Rheumatoid arthritis (RA) patients face a high risk of serious infections (SIs), a leading cause of mortality.
  • Corticosteroid (CS) use is a known risk factor for SIs in RA.
  • Mannose-binding lectin (MBL) is a key component of innate immunity, with deficiency potentially impacting infection risk.

Purpose of the Study:

  • To investigate if MBL deficiency is a risk factor for SIs in RA patients.
  • To compare the SI risk associated with MBL deficiency against CS use and disease-modifying antirheumatic drug (DMARD) therapies (synthetic and biologic).

Main Methods:

  • A longitudinal observational study of 228 RA patients over a median of 5.9 years.
  • Serum MBL concentrations were measured in all patients.
  • Data on synthetic (n=96) and biologic (n=132) DMARD use and serious infections were collected.

Main Results:

  • Serious infections (SIs) occurred in 17% of RA patients, regardless of treatment.
  • Both undetectable MBL levels (<56 ng/mL) and maintenance prednisolone (≥10 mg/day) significantly increased SI risk (IRR 4.67 and 4.70, respectively).
  • No substantial increase in SI risk was observed with biologic DMARD use compared to synthetic DMARDs.

Conclusions:

  • Undetectable MBL and high-dose corticosteroid use are significant, previously unrecognized risk factors for SIs in RA.
  • Biologic DMARDs appear safe regarding serious infection risk in this RA cohort.
  • MBL deficiency should be considered in the risk assessment for serious infections in RA patients.