1
|
Avci AB, Feist E, Burmester GR. Rheumatoid factors revisited in the age of biologic therapy. Rheumatology (Oxford) 2025; 64:ii15-ii24. [PMID: 39982406 PMCID: PMC11981325 DOI: 10.1093/rheumatology/keaf035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 12/02/2024] [Accepted: 12/10/2024] [Indexed: 02/22/2025] Open
Abstract
The discovery of RF has been instrumental in diagnosing and classifying RA. Various RF isotypes, including IgM-RF and IgA-RF, have been linked to disease severity and treatment responses. The role of RF in RA pathogenesis, primarily through the formation of immune complexes, also carries the potential to influence the response to different medications. Recent progress in biologic therapies has further elucidated the role of RF in RA management. Treatments such as rituximab, abatacept and tocilizumab have shown differential efficacy based on RF status, with RF-positive patients often exhibiting better responses. Recent research also suggests that TNF inhibitors (TNFi) lacking the IgG1-Fc fragment like certolizumab pegol (CZP) may offer advantages over TNFi with an IgG1-Fc fragment, in RF-positive patients by preventing immune complex formation. Since this early observation is predominantly derived from previous multicentre studies with heterogeneous populations and potentially varying RF measurement methods, prospective randomized studies directly addressing this issue are essential for a more thorough and reliable evaluation. This paper is a narrative review outlining the evolving understanding of RF in the context of biologic therapies, emphasizing the need for personalized treatment approaches based on serological profiles and underlying immune mechanisms.
Collapse
Affiliation(s)
- Ali Berkant Avci
- Department of Internal Medicine, Rheumatology, Medical Park Antalya Hospital, Antalya, Türkiye
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology, Helios Clinic, Vogelsang-Gommern, Germany
- Experimental Rheumatology, Otto-von-Guericke University, Magdeburg, Germany
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
2
|
Autoantibodies as Diagnostic Markers and Mediator of Joint Inflammation in Arthritis. Mediators Inflamm 2019; 2019:6363086. [PMID: 31772505 PMCID: PMC6854956 DOI: 10.1155/2019/6363086] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/14/2019] [Indexed: 12/11/2022] Open
Abstract
Rheumatoid arthritis is a systemic, polygenic, and multifactorial syndrome characterized by erosive polyarthritis, damage to joint architecture, and presence of autoantibodies against several self-structures in the serum and synovial fluid. These autoantibodies (anticitrullinated protein/peptide antibodies (ACPAs), rheumatoid factors (RF), anticollagen type II antibodies, antiglucose-6 phosphate isomerase antibodies, anticarbamylated protein antibodies, and antiacetylated protein antibodies) have different characteristics, diagnostic/prognostic value, and pathological significance in RA patients. Some of these antibodies are present in the patients' serum several years before the onset of clinical disease. Various genetic and environmental factors are associated with autoantibody production against different autoantigenic targets. Both the activating and inhibitory FcγRs and the activation of different complement cascades contribute to the downstream effector functions in the antibody-mediated disease pathology. Interplay between several molecules (cytokines, chemokines, proteases, and inflammatory mediators) culminates in causing damage to the articular cartilage and bones. In addition, autoantibodies are proven to be useful disease markers for RA, and different diagnostic tools are being developed for early diagnosis of the clinical disease. Recently, a direct link was proposed between the presence of autoantibodies and bone erosion as well as in the induction of pain. In this review, the diagnostic value of autoantibodies, their synthesis and function as a mediator of joint inflammation, and the significance of IgG-Fc glycosylation are discussed.
Collapse
|
3
|
Using the Immunophenotype to Predict Response to Biologic Drugs in Rheumatoid Arthritis. J Pers Med 2019; 9:jpm9040046. [PMID: 31581724 PMCID: PMC6963853 DOI: 10.3390/jpm9040046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 01/09/2023] Open
Abstract
Tumour necrosis factor (TNF)-α is a key mediator of inflammation in rheumatoid arthritis, and its discovery led to the development of highly successful anti-TNF therapy. Subsequently, other biologic drugs targeting immune pathways, namely interleukin-6 blockade, B cell depletion, and T cell co-stimulation blockade, have been developed. Not all patients respond to a biologic drug, leading to a knowledge gap between biologic therapies available and the confident prediction of response. So far, genetic studies have failed to uncover clinically informative biomarkers to predict response. Given that the targets of biologics are immune pathways, immunological study has become all the more pertinent. Furthermore, advances in single-cell technology have enabled the characterization of many leucocyte subsets. Studying the blood immunophenotype may therefore, define biomarker profiles relevant to each individual patient's disease and treatment outcome. This review summarises our current understanding of how immune biomarkers might be able to predict treatment response to biologic drugs.
Collapse
|
4
|
Mohammed RHA, Farahat F, Kewan HH, Bukhari MA. Predictors of European League Against Rheumatism (EULAR) good response, DAS-28 remission and sustained responses to TNF-inhibitors in rheumatoid arthritis: a prospective study in refractory disease. SPRINGERPLUS 2015; 4:207. [PMID: 25977895 PMCID: PMC4422826 DOI: 10.1186/s40064-015-0979-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 04/13/2015] [Indexed: 02/07/2023]
Abstract
The aim of this study was to survey factors related to EULAR good response, the DAS-28 definition of remission, ACR 50 response, sustained response to tumor necrosis factor inhibitors (TNF-I) therapy in biologic naïve patients with refractory rheumatoid arthritis. This was a single center observational clinical prospective 2 years' study, EULAR response criteria, DAS 28, HAQ and radiographic changes were recorded. Eighty patients included (64 females and 16 males, mean age was 48.4 + -17.9 years, mean disease duration 7.3 + -5.9 years). At 6 months 70% achieved EULAR good response, 51.8% achieved DAS-28 remission. Good response/sustained responses inversely correlated with baseline DAS-28 and radiographic erosions P <0.05. EULAR good response/remission by 6 months, sustained response at 2 years positively correlated with the decline in RF titers (r = 0.33, P < 0.05 & r = 0.30, P < 0.03 respectively), negatively correlated with the baseline HAQ. Regression analysis identified higher serum hemoglobin concentration, lower baseline HAQ scores, and the absence of radiographic erosions as significant predictors of good as well as sustained responses after adjustment for potential covariates. Methotrexate was associated with favorable responses and remission at 6 months (ORs = 1.13, 1.30 respectively). The study concluded that a lower baseline DAS-28 and HAQ scores, the lack of radiographic erosions favored EULAR good response and were significant predictors of sustained response to TNF-I.
Collapse
Affiliation(s)
- Reem Hamdy A Mohammed
- />Rheumatology and Clinical Immunology, Department of Rheumatology and Rehabilitation, School of Medicine, Cairo University Hospitals, Cairo, Egypt
- />Internal Medicine Department, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Faisal Farahat
- />Community Medicine, Munofia University, Munofia, Egypt
- />Research Department Al Hada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Hanady H Kewan
- />Department of Radio-diagnosis, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- />Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Mohammed A Bukhari
- />Internal Medicine Department, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| |
Collapse
|
5
|
Aberumand B, Barra L, Cao Y, Riche NL, Thompson AE, Rohekar G, Rohekar S, Bonner A, Pope JE. Response to Tumor Necrosis Factor Inhibitors in Rheumatoid Arthritis for Function and Pain is Affected by Rheumatoid Factor. Open Rheumatol J 2014; 8:73-6. [PMID: 25352925 PMCID: PMC4209495 DOI: 10.2174/1874312901408010073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/02/2014] [Accepted: 10/03/2014] [Indexed: 11/22/2022] Open
Abstract
Objectives : To investigate differences in response to tumor necrosis factor inhibitor treatment (TNFi) in seropositive (rheumatoid factor positive; RF+) versus seronegative (RF-) patients with established RA as measured by the Health Assessment Questionnaire Disability Index (HAQ-DI) and pain. Methods : RA patients from an established RA cohort were studied according to rheumatoid factor (RF) status for change in HAQ-DI and pain (0-3 VAS) one year after starting treatment with a TNFi. Results : There were 238 patients treated with TNFi who had follow-up data (178 RF+ and 60 RF-). Disease duration was longer in RF+ vs RF- (12+8 vs 8+8 years) but the proportion of females (82% vs 72%, P=0.7), baseline HAQ-DI (1.44+0.63 vs 1.41+0.63, P=0.8) and pain (1.92+0.67 vs 1.93+0.67, P=0.9) were not different. The mean duration of treatment of first TNFi was 2.8 vs 2.3 years, P=0.1 and 68% of RF+ vs 62% of RF- were still receiving first TNFi at last visit (P=0.5). For patients with data at baseline and one year, the one-year HAQ-DI change was significantly greater in 90 RF+ patients (-0.356) versus 38 RF- patients (-0.126; P=0.04). The mean pain improvement was also greater in 77 RF+ vs 32 RF- patients (-0.725 vs -0.332 respectively; P=0.03). Numbers are small, data are missing and comorbidities, DAS28 and anti-CCP were not collected. Conclusion : Despite limitations in the data, in established RA after failure of DMARDs, RF+ patients may be more responsive to TNFi therapy as measured by changes in HAQ-DI and pain. Innovation : There may be a better response to TNFi in RA if RF positive for function and pain.
Collapse
Affiliation(s)
- Babak Aberumand
- Schulich School of Medicine & Dentistry, University of Western Ontario, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care, Ontario, Canada
| | - Lillian Barra
- Schulich School of Medicine & Dentistry, University of Western Ontario, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care, Ontario, Canada
| | - Yang Cao
- Schulich School of Medicine & Dentistry, University of Western Ontario, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care, Ontario, Canada
| | - Nicole Le Riche
- Schulich School of Medicine & Dentistry, University of Western Ontario, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care, Ontario, Canada
| | - Andrew E Thompson
- Schulich School of Medicine & Dentistry, University of Western Ontario, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care, Ontario, Canada
| | - Gina Rohekar
- Schulich School of Medicine & Dentistry, University of Western Ontario, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care, Ontario, Canada
| | - Sherry Rohekar
- Schulich School of Medicine & Dentistry, University of Western Ontario, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care, Ontario, Canada
| | - Ashley Bonner
- Schulich School of Medicine & Dentistry, University of Western Ontario, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care, Ontario, Canada
| | - Janet E Pope
- Schulich School of Medicine & Dentistry, University of Western Ontario, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care, Ontario, Canada
| |
Collapse
|
6
|
Salgado E, Campos J, Moreira-Navarrete V, Mulero J, Navarro F, Pérez-Pampín E, Carmona L, Gómez-Reino J. Rheumatoid factor does not predict response to TNF antagonists in rheumatoid arthritis: Three centers experience. Joint Bone Spine 2013; 80:438-40. [DOI: 10.1016/j.jbspin.2013.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 01/08/2013] [Indexed: 10/27/2022]
|
7
|
Salgado E, Maneiro JR, Carmona L, Gómez-Reino J. Rheumatoid factor and response to TNF antagonists in rheumatoid arthritis: systematic review and meta-analysis of observational studies. Joint Bone Spine 2013; 81:41-50. [PMID: 23731644 DOI: 10.1016/j.jbspin.2013.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To systematically analyze literature with the aim of examining whether rheumatoid factor (RF) is a predictor of response to tumor necrosis factor (TNF) antagonists in rheumatoid arthritis (RA). METHODS A systematic review and meta-analysis of observational studies were conducted. All studies on the association of baseline RF (titer and/or status) and response to any TNF antagonists, or with enough information to estimate this association were included. Qualitative analysis and meta-analysis using random-effects approach by type of outcome response and RF test was performed. Risk of publication bias was also evaluated. RESULTS The systematic review included 18 studies of 4163 identified articles, involving 5703 patients with homogeneous baseline characteristics. The most common outcome to assess response was European League Against Rheumatism (EULAR) response criteria, normally merging good and moderate categories as response. The weighted mean difference (WMD) of baseline IgM RF titer in meta-analysis was higher in the non-responders group [-101.58 (95% CI -156.58,-46.59) I2=0.0]. Combined odds ratios (ORs) of positive IgM RF, positive IgA RF, and positive IgG RF to achieve good/moderate response were 1.08 (0.80, 1.47), I2=40.9%; 0.83 (0.39, 1.73), I2=39.8%, and 1.30 (0.48, 3.51), I2=62.9%, respectively. We did not find an association between a positive IgM RF and EULAR good response or remission. CONCLUSIONS This meta-analysis does not support baseline IgM RF titer as a predictor of response to TNF antagonists in RA. However, this conclusion is hampered by high heterogeneity in the studies included in this meta-analysis.
Collapse
Affiliation(s)
- Eva Salgado
- Rheumatology Division, Complejo Hospitalario Universitario de Santiago, Travesía da Choupana s/n, 15701 Santiago de Compostela, Spain.
| | - José Ramón Maneiro
- Rheumatology Division, Complejo Hospitalario Universitario de Santiago, Travesía da Choupana s/n, 15701 Santiago de Compostela, Spain
| | - Loreto Carmona
- Rheumatology Division, Complejo Hospitalario Universitario de Santiago, Travesía da Choupana s/n, 15701 Santiago de Compostela, Spain; Health Sciences School, Universidad Camilo José Cela, Madrid, Spain
| | - Juan Gómez-Reino
- Rheumatology Division, Complejo Hospitalario Universitario de Santiago, Travesía da Choupana s/n, 15701 Santiago de Compostela, Spain; Department of Medicine, Facultad de Medicina, Universidad de Santiago, Santiago de Compostela, Spain
| |
Collapse
|
8
|
Wang Q, Ma Y, Liu D, Zhang L, Wei W. The Roles of B Cells and Their Interactions with Fibroblast-Like Synoviocytes in the Pathogenesis of Rheumatoid Arthritis. Int Arch Allergy Immunol 2011; 155:205-11. [DOI: 10.1159/000321185] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|