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Results

The results of the serum immunoglobulin estimations are shown in Table 1. The mean serum IgA in AS patients was 307 mg/dl compared to a mean serum IgA of 223 mg/dl in the control group. This is an increase of 38% and is statistically significant (/=3-14, P<0-005). (SI conversion: g/l=mg/dl x 0-01). There was a slight rise in mean serum IgG and IgM estimations in AS patients when compared to control subjects, but this difference was not statistically significant (Table 1).

In an endeavour to study further the distribution pattern of serum IgA, AS patients were divided into 2 groups according to their ESR: one group consisting of patients with an ESR below 15 mm/h ("normal ES") and the other group consisting of patients having an ESR of 15 mm/h or more ("elevated ESR"). The mean serum IgA in patients having an "elevated ESR" was 369 mg/dl (Fig. 1A), while in AS patients having a "normal ESR" it was 236 mg/dl, and this difference is statistically significant (/=5-64, P<0-001). The mean serum IgA in patients with an "elevated ESR" was 65%, higher than the mean serum IgA in control subjects (7=4-52, P<0-001). Furthermore there was no significant difference between the mean serum IgA in AS patients with a "normal ESR" and the mean serum IgA in control subjects (Fig. 1A).

Samples for CRP estimations were selected randomly from the pool of patient sera available. The patients were divided into 2 groups according to their CRP level: one group consisting of patients with a CRP below 15 (ig/ml and the second group having a CRP of 15 fig/ml (15 mg/1) or more (Fig.1A). It was considered that patients having the higher level of CRP were more likely, as a group, to be in an active inflammatory phase of the disease. The mean serum IgA in patients having an elevated CRP was 387-8 mg/dl, while in patients having the lower CRP (Fig. 1A) it was 236-5 mg/dl, and this difference is statistically significant (7=3-68, P<0-001). The mean serum IgA in patients with an elevated CRP value was 74% higher than in control subjects (/=4-54, P<0-001). Again as in the previous ESR comparison there was no significant difference between the mean serum IgA of the low CRP group and the control subjects.

400r
300
Serum IgA mg/dl
200
100
Number of Estimations
o1-

 

4n

A

+

   

+

 
             

65

       

+1
115

     
 

221

           
           

57

 
     

89

       

rf-
58

             

Control AM Subjects Patients 1 II

 

ESR< 15 ESR >K CRF<KCRf>K ikylosing Spondylitis Patients |

Fig. 1 Serum IgA (mean ~ standard error) (Fig. JA), IgG (Fig. IB), and IgM (Fig. 1C) measured in healthy control subjects and AS patients. Mean serum immunoglobulin levels in patients with elevated erythrocyie sedimentation rate (ESR > 15 mmjh) and elevated C-reactive protein levels (CRP ~z 15 v.glml) were also compared to sera from patients having normal (ESR <15 mm/h) or low (CRP <15 \Lglml) values.

Table 1 The mean (i SEM) serum immunoglobulin levels in healthy control subjects and AS patients

 

Controls

Ankylosing spondylitis patients

Statistical significance

 

Mean±SE (me/dl)

Kumbtr of estimations

Mtan±SE (mglJlt

Number of estimations

 

Serum IgA
Serum IgG Serum IgM

223±11
1263d- 36 140±6

58
58
58

307±13
1361 ±30 149±6

221
195 185

f = 3-140 P<0-005 NS NS

SI conversion: g/1-mg/dl x 0-01. NS = not significant.

1500
Serum IgG
mg;d!
1000
500
Number of Estimations
0

     

A

 

-H

 

T

 

-

       

102

   

i 51

     

I 195

           
   

58

             
         

81

       
               

45

 
   

Control All Subjects Patients 11

 

£SR<15ESR>15 nkylosing Spondylitis

CRP<15CRP>15 Patients

 

IgG

The mean serum IgG in AS patients was 1361 mg/dl, which is a rise of 8% compared with the mean serum IgG obtained for control subjects, but this difference is not statistically significant. However, when the AS patients were divided into groups with increased inflammatory activity (ESR^IS mm/h and CRP^IS fJtg/ml), again there was a rise in the mean serum IgG when compared with the level in control subjects (Fig. IB). The mean serum IgG in patients with an elevated ESR was 1508 mg/dl and this 20% rise, when compared to control subjects, is statistically significant (/=3"85, P<0-001). The mean serum IgG in patients with an elevated CRP was 1468 mg/dl, and this 16% rise, when compared with the level in control subjects, is also statistically significant (/=3-40, P<0-001). There was no significant difference between mean serum IgG levels in patients with "normal" ESR and low CRP values when compared with control subjects.

zoo

ISO
Serum IgM mg"dl

 

-i-

     

il

 

-h

 
     

+|

 

+

     

--

                   

IX

-

               

50

-

               

Number of Estimations
0

 

58

185

A

75

98

 

39

46

 

Control All Subjects Patients 1 11

 

ESR<15£SR>15 CRP< 15 CRP>I5 ikylosing Suondylitis Patients j

IgM

The mean serum IgM in AS patients was 149 mg/dl, which is a 6% rise compared to the mean serum IgM obtained for control subjects, but this difference is not statistically significant (Fig. 1C). Furthermore, when patients were divided into groups with increased inflammatory activity, again there was no statistically significant difference between serum IgM levels in patients with elevated ESR or CRP and control subjects (Fig. 1C) or patients with "normal" ESR and low CRP values.

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