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Paper |
1 LIIPAT, Institute of Pathology, University of Oslo, Norway
2 Department of Rheumatology, Södersjukhuset Stockholm, Sweden
3 Department of Internal Medicine, University Hospital, Uppsala, Sweden
* To whom correspondence should be addressed. E-mail: per.brandtzaeg{at}medisin.uio.no.
Accepted 1 February 2006
 | Abstract |
|---|
Background: Patients with rheumatoid arthritis (RA) often feel an association between food intake and their disease severity.
Methods: To substantiate immunologically a
connection between RA and intestinal immunity, we
measured IgG, IgA, and IgM antibodies to dietary antigens
in serum and jejunal perfusion fluid from 17 RA patients
and 20 healthy subjects. The antigens originated from
cow's milk (
-lactalbumin, 
-lactoglobulin,
casein), cereals, hen's egg (ovalbumin), cod fish, and
pork meat.
Results: In intestinal fluid of many RA patients,
all three Ig classes showed elevated food-specific
activities. Except for IgM activity against -
lactoglobulin, all other IgM activities were highly
significantly increased unrelated to the elevation of
total IgM. The RA-associated serum IgM antibody
responses were relatively much less pronounced. Compared
with IgM, the intestinal IgA activities were less
consistently elevated, with no significant increase
against gliadin and casein. Considerable cross-reactivity
of IgM and IgA antibodies was documented by absorption
tests. Although intestinal IgG activity to food was quite
low, it was nevertheless significantly increased against
many antigens in RA patients. Three of the five RA
patients treated with sulfasalazine for 16 weeks had
initially raised levels of intestinal food antibodies;
these became normalized after treatment but clinical
improvement was rather reflected in a reduced erythrocyte
sedimentation rate.
Conclusion: The production of cross-reactive antibodies is strikingly elevated in the gut of many RA patients. Their food-related problems might reflect an adverse additive effect of multiple modest hypersensitivity reactions mediated, for instance, by immune complexes promoting autoimmune reactions in the joints.
Keywords: food antibodies, inflammation, intestinal mucosa, rheumatoid arthritis
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