Higher Levels of Secretory IgA Are Associated with Low Disease Activity Index in Patients with Reactive Arthritis and Undifferentiated Spondyloarthritis

Abstract

IntroductionBoth reactive arthritis (ReA) and undifferentiated spondyloarthritis (uSpA) belong to the group of autoinflammatory diseases called spondyloarthritis (SpA). Hypotheses have been proposed about a relationship between the intestinal mucosa and inflammation of joint tissues. The role of immunoglobulin IgA or secretory immunoglobulin A (SIgA) in the inflammatory and/or clinical activity of patients with SpA remains poorly understood.ObjectiveTo evaluate the status of total IgA and SIgA, and the association among the levels of SIgA, IgA, IgA anti-Chlamydia trachomatis, and anti-Shigella spp. with the disease activity measures, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, was compared in a cohort of patients with ReA and uSpA and healthy subjects.MethodsThis was a cross-sectional study. The serum concentrations of SIgA, IgA anti-C. trachomatis, anti-Shigella spp., and total IgA were measured. Disease activity was measured in each patient by means of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). Statistical analysis did include as bivariate evaluation, comparisons by Student’s t-test, Kruskal–Wallis test, and U Mann–Whitney test, with a multivariate evaluation by principal components analysis (PCA). A correlation analysis was carried out using the Pearson correlation coefficient and a linear regression models. All analysis were made using Stata version 11.2® for Windows, R V3.3.21. Statistical significance was defined a p-value <0.05.ResultsIn all, 46 patients (78.2% men; mean age, 34.8 ± 12.3 years) and 53 controls (41% men; mean age, 32 ± 11.4 years) were included in the study. The mean serum levels of SIgA were higher in SpA patients than in healthy subjects (p < 0.001). Only SIgA levels correlated with disease activity: BASDAI (r = −0.42, p = 0.0046), ASDAS-CRP (r = −0.37, p = 0.014), and ASDAS-ESR (r = −0.45, p = 0.0021). The negative correlation between SIgA and all activity indices was higher in HLA-B27-positive patients (BASDAI r = −0.70, p = 0.0009, ASDAS-CRP r = −0.58, p = 0.0093, and ASDAS-ESR r = −0.57, p = 0.0083). The PCA showed three factors: the first component was constituted by variables referred as clinical activity measures, the second did include the serological activity markers, and the last component was compounded by age and symptoms time.ConclusionElevated serum levels of SIgA were found to be related with low disease activity in patients with ReA and uSpA.

Gastrointestinal Symptoms and Elevated Levels of Anti-Saccharomyces cerevisiae Antibodies Are Associated with Higher Disease Activity in Colombian Patients with Spondyloarthritis

“…This may be explained by differences with regard to ethnic and geographic variation. According to our results, the gastrointestinal manifestations are higher than previously reported in the literature [ 36 ]. This is mainly because this kind of complaints is not systematically investigated during clinical care in patients with SpA.…”

Risk Factors of Renal Involvement Based on Different Manifestations in Patients with Ankylosing Spondylitis

“…Serotype IgA is associated with elevated secretion of IgA, whereas secretory IgA is the major antibody found in the secretory fluid, which is involved in local mucosal protection. Studies have shown that there is a negative correlation between the activity of secretory IgA and AS disease, and that a higher level of secretory IgA, correlates with a lower activity of AS [28]. Therefore, we concluded that in AS patients, increased serum levels of IgA were associated with increased secretion of secretory IgA and neutralizing antigen, thereby becoming a risk factor for renal involvement in AS.…”

Usefulness of complex bacteriological and serological analysis in patients with spondyloarthritis

“…Previous studies have suggested that mucous membranes and their immune systems serve a pathological role in the development and maintenance of numerous auto-inflammatory diseases, including SpA (70–72). Salas-Cuestas et al (71) reported that there was a higher mean SgA concentration in patients with ReA and uSpA, independent of the HLA-B27 allele and disease duration. In the study of Granfors and Toivanen (72), there was a significant difference in the serum levels of SIgA, particularly anti- Yersinia enterocolitis in patients who developed arthritis following a confirmed infection.…”