title: Nonspecific elevation of serum Aspergillus galactomannan antigen levels in patients with rheumatoid arthritis.
abstract: BACKGROUND
  Infections are an important cause of morbidity and mortality in patients with rheumatoid arthritis. Patients receiving immunosuppressive or anti-tumor necrosis factor (TNF) agents are vulnerable to fungal infections, including those derived from Aspergillus species. Detection of the Aspergillus galactomannan antigen in serum is useful for the early diagnosis of invasive aspergillosis in patients with hematological malignancies. However, its usefulness for detecting early invasive aspergillosis in rheumatoid arthritis patients remains unestablished.
  
  
  METHODS
  Galactomannan antigen levels were measured in 340 patients (311 female patients). For patients who exhibited galactomannan antigen levels ≥0.5 during the initial examination, a second examination was performed 3-6 months later. Conventional blood tests and chest radiography were also performed.
  
  
  RESULTS
  Elevated galactomannan antigen levels (≥0.5) were observed in 62 (18.2%) of 340 patients during the initial examination. A second examination was performed in 56 of 62 patients, 50 of whom exhibited elevated antigen levels. Elevated antigen levels were not associated with the use of any drug including anti-TNF agents. Serum galactomannan antigen levels were correlated with the albumin/globulin ratio (r=-0.19, p<0.001), γ-globulin (%; r=0.17, p=0.001), and hemoglobin concentration (r=-0.15, p=0.005). No patient was clinically diagnosed with invasive aspergillosis during the study period.
  
  
  CONCLUSIONS
  Serum galactomannan antigen levels are frequently elevated in a nonspecific manner in patients with rheumatoid arthritis.
authors.affiliation: Department of Clinical Laboratory, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan. Electronic address: mhorie-tky@umin.ac.jp.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Horie
authors.affiliation: Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, 173-8605 Tokyo, Japan. Electronic address: tamiya-nii@umin.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tamiya
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan. Electronic address: ygoto-tky@umin.net.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Goto
authors.affiliation: Department of Respiratory Medicine, Kanto Central Hospital, 6-25-1, Kamiyoga, Setagaya-ku, Tokyo 158-0098, Japan; Department of Allergy and Rheumatology, Kanto Central Hospital, 6-25-1, Kamiyoga, Setagaya-ku, Tokyo 158-0098, Japan. Electronic address: masaruszk@aol.com.
authors.forename: Masaru
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan. Electronic address: matsuzakih-int@h.u-tokyo.ac.jp.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Matsuzaki
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan. Electronic address: Hasegawawakaetnk0703@yahoo.co.jp.
authors.forename: Wakae Tanaka
authors.initials: WT
authors.lastname: Hasegawa
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan. Electronic address: snoguchi326@yahoo.co.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Noguchi
authors.affiliation: Department of Respiratory Medicine, Kanto Central Hospital, 6-25-1, Kamiyoga, Setagaya-ku, Tokyo 158-0098, Japan. Electronic address: kawakamim-tky@umin.ac.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kawakami
authors.affiliation: Matsuta Clinic, 2-28-8, Daizawa, Setagaya-ku, Tokyo 155-0032, Japan. Electronic address: kunio1944@jcom.home.ne.jp.
authors.forename: Kunio
authors.initials: K
authors.lastname: Matsuta
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan. Electronic address: takahide-tky@umin.ac.jp.
authors.forename: Takahide
authors.initials: T
authors.lastname: Nagase
authors.affiliation: Department of Respiratory Medicine, Kanto Central Hospital, 6-25-1, Kamiyoga, Setagaya-ku, Tokyo 158-0098, Japan. Electronic address: sakamoto@kanto-ctr-hsp.com.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Sakamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000946:Antigens, Fungal / Q000097:blood*; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000188:drug therapy; D001228:Aspergillosis / Q000175:diagnosis; D001230:Aspergillus / Q000276:immunology*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006942:Hypergammaglobulinemia / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008351:Mannans / Q000276:immunology*; D008875:Middle Aged
chemical_list: D000946:Antigens, Fungal; D015415:Biomarkers; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D008351:Mannans; C012990:galactomannan; D005690:Galactose
keywords: Galactomannan antigen; Infection; Invasive aspergillosis; Rheumatoid arthritis