title: Diagnostic performance of measuring antibodies to the glycopeptidolipid core antigen specific to Mycobacterium avium complex in patients with rheumatoid arthritis: results from a cross-sectional observational study.
abstract: BACKGROUND
  The aim of this study was to investigate the diagnostic performance of measuring antibodies to the glycopeptidolipid (GPL) core antigen specific to Mycobacterium avium complex (MAC) in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  We cross-sectionally investigated anti-GPL antibodies and radiographs of 396 patients with RA. A diagnosis of MAC pulmonary disease (MAC-PD) was made according to the criteria by the American Thoracic Society and the Infectious Diseases Society of America. Serum immunoglobulin A antibodies to MAC-specific GPL core antigen were measured by an enzyme immunoassay. All patients with RA with abnormal shadows on chest x-rays underwent chest computed tomography (CT). Bronchoscopy was performed on patients with negative cultures for MAC by expectorated sputum and positive CT findings compatible with MAC-PD.
  
  
  RESULTS
  Ten patients were newly diagnosed with MAC-PD. Eight individuals who already had diagnoses of MAC-PD at the time of enrollment and nineteen who had negative expectorated sputum cultures for MAC and positive CT images compatible with MAC-PD and who refused bronchoscopy were excluded from the following analysis. Anti-GPL antibodies were detected in 12 of 369 patients. Eight of the ten patients with MAC-PD and 4 of 359 patients without MAC-PD tested positive for the anti-GPL antibodies. The specificity and sensitivity were 99 % and 80 %, respectively. Positive and negative predictive values were 67 %, and 97 %, respectively. When we analyzed diagnostic performance of the antibodies in 57 patients with RA who had abnormal shadows on chest x-rays, the positive and negative predictive values were 100 %, and 96 %, respectively. Twelve patients underwent bronchoscopy. Bronchoalveolar lavage fluid (BALF) samples from six patients were positive for MAC, and BALF samples from the remainder were negative. Anti-GPL antibodies were detected in the sera of all six patients with positive results for MAC by BALF sampling, whereas the antibodies were not detected in the sera from the remainder with negative results for MAC by BALF sampling.
  
  
  CONCLUSIONS
  The measurement of anti-GPL antibodies is useful as a supplementary diagnostic tool for MAC-PD in patients with RA and may provide a new strategy, in combination with chest x-ray and CT, for differentiating MAC-PD from other pulmonary comorbidities in patients with RA.
authors.affiliation: Hirose Clinic of Rheumatology, 2-14-7, Midori-cho, Tokorozawa city, Saitama, 359-1111, Japan. hirosew@jcom.home.ne.jp.
authors.forename: Wataru
authors.initials: W
authors.lastname: Hirose
authors.affiliation: Division of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Society, 3-1-24, Matsuyama, Kiyose city, Tokyo, 204-8522, Japan. uchiyamat@fukujuji.org.
authors.forename: Takashi
authors.initials: T
authors.lastname: Uchiyama
authors.affiliation: Graduate School of Public Health, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. anemoto@med.teikyo-u.ac.jp.
authors.forename: Asuka
authors.initials: A
authors.lastname: Nemoto
authors.affiliation: Department of Pharmacovigilance, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. mharigai.mpha@tmd.ac.jp.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Harigai
authors.affiliation: Division of Rheumatology, National Defense Medical College, 3-2, Namiki, Tokorozawa city, Saitama, 359-0042, Japan. kenjiky@ndmc.ac.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Itoh
authors.affiliation: Department of Pharmacology, National Defense Medical College, 3-2, Namiki, Tokorozawa city, Saitama, 359-0042, Japan. tishizu@ndmc.ac.jp.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Ishizuka
authors.affiliation: Hirose Clinic of Rheumatology, 2-14-7, Midori-cho, Tokorozawa city, Saitama, 359-1111, Japan. mmitsu@yahoo.co.jp.
authors.forename: Mitsuyo
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: Graduate School of Public Health, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. kazue@med.teikyo-u.ac.jp.
authors.forename: Kazue
authors.initials: K
authors.lastname: Yamaoka
authors.affiliation: Department of Clinical Research Medicine, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. toshihiro.nanki@med.toho-u.ac.jp.|Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan. toshihiro.nanki@med.toho-u.ac.jp.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nanki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood / Q000276:immunology*; D001172:Arthritis, Rheumatoid / Q000276:immunology* / Q000382:microbiology; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy; D003430:Cross-Sectional Studies; D005260:Female; D006017:Glycolipids / Q000276:immunology*; D054884:Host-Pathogen Interactions / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood / Q000276:immunology; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex / Q000276:immunology* / Q000502:physiology; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis / Q000276:immunology* / Q000382:microbiology; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology
chemical_list: D000907:Antibodies, Bacterial; D006017:Glycolipids; D007070:Immunoglobulin A