School 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.
Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia.
J Allergy Clin Immunol Pract. 2017 Nov-Dec;5(6):1609-1616. doi: 10.1016/j.jaip.2017.02.025. Epub 2017 Jun 19.
Infection is the leading cause of death in rheumatoid arthritis (RA). Corticosteroid (CS) use is a known and important risk factor for serious infections (SIs). Mannose binding lectin (MBL) is a genetically determined component of the innate immune system implicated in neonatal infections.
Our aim was to determine whether MBL deficiency is a risk factor for SIs in RA and to compare it with CS use and also synthetic and biologic disease-modifying antirheumatic drug (DMARD) therapy.
Data on 228 patients with RA were collected for up to 7 years (median = 5.9 years). Serum MBL concentrations were determined in all patients receiving synthetic (n = 96) or biologic (n = 132) DMARD therapy.
High rates of SIs were observed in RA irrespective of treatment (17%). Similar rates of SIs were observed in synthetic and biologic DMARD users. The rates of single and multiple SIs were similar, irrespective of the use of a biologic agent. Undetectable MBL (<56 ng/mL) concentrations and maintenance prednisolone at 10 mg per day or higher were associated with an increased risk for an SI, with incident risk ratio of 4.67 (P = .001) and 4.70 (P < .001), respectively.
Undetectable MBL and prednisolone confer a high risk for an SI. The use of biologic DMARDs did not confer substantial SI risk in this observational study. MBL deficiency is hitherto an unrecognized risk factor for an SI in RA.
感染是类风湿关节炎（RA）死亡的主要原因。皮质类固醇（CS）的使用是严重感染（SI）的一个已知且重要的危险因素。甘露糖结合凝集素（MBL）是先天免疫系统中一种遗传决定的成分，与新生儿感染有关。
我们旨在确定 MBL 缺乏是否是 RA 患者发生 SI 的危险因素，并将其与 CS 应用以及合成和生物疾病修饰抗风湿药物（DMARD）治疗进行比较。
对 228 例 RA 患者的数据进行了长达 7 年（中位数= 5.9 年）的收集。所有接受合成（n=96）或生物（n=132）DMARD 治疗的患者均测定血清 MBL 浓度。
RA 患者无论接受何种治疗（17%），均观察到高发生率的 SI。在合成和生物 DMARD 使用者中，SI 的发生率相似。无论是否使用生物制剂，单次和多次 SI 的发生率相似。无法检测到的 MBL（<56ng/ml）浓度和维持泼尼松剂量为 10mg/天或更高与发生 SI 的风险增加相关，发病风险比分别为 4.67（P=0.001）和 4.70（P<0.001）。
无法检测到的 MBL 和泼尼松可增加发生 SI 的风险。在这项观察性研究中，生物 DMARD 的使用并未带来实质性的 SI 风险。MBL 缺乏是 RA 患者发生 SI 的一个以前未被认识到的危险因素。
