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The significance and predictive value of free light chains in the urine of patients with chronic inflammatory rheumatic disease

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Abstract

In patients with rheumatic diseases, reliable markers for determining disease activity are scarce. One potential parameter is the level of immunoglobulin free light chains (FLCs), which is known to be elevated in the blood of patients with certain rheumatic diseases. Few studies have quantified FLCs in urine, a convenient source of test sample, in patients with different rheumatic diseases. We carried out a retrospective analysis of patients with rheumatic disease attending the University hospital of Goettingen, Germany. Subjects were included if they had urine levels of both κ and λ FLCs available and did not have myeloma. Data regarding systemic inflammation and kidney function were recorded, and FLC levels were correlated with inflammatory markers. Of the 382 patients with rheumatic disease, 40.1 % had chronic polyarthritis, 21.2 % connective tissue disease, 18.6 % spondyloarthritis and 15.7 % vasculitis. Elevated levels of κ FLCs were found for 84 % of patients and elevated λ for 52.7 %. For the patients with rheumatoid arthritis, FLCs correlated with C-reactive protein (κ, r = 0.368, p < 0.001; λ, r = 0.398, p < 0.001) and erythrocyte sedimentation rate (κ, r = 0.692, p < 0.001; λ, r = 0.612, p < 0.001). Patients being treated with rituximab displayed FLC levels similar to those of the reference group. There were clear elevations in both κ and λ FLCs in patients with rheumatic disease, but not in κ/λ ratio. The correlation between FLCs and inflammatory markers in patients with rheumatoid arthritis demonstrates their potential for predicting disease activity.

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Authors and Affiliations

  1. Department of Nephrology and Rheumatology, Georg-August-University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany

    Carsten Paul Bramlage, Britta Froelich, Manuel Wallbach, Michael Koziolek & Gerhard Anton Müller

  2. Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany

    Carsten Paul Bramlage, Joan Minguet, Cornelia Deutsch & Peter Bramlage

  3. Department of Medicine III, Hospital Bamberg, Bamberg, Germany

    Clemens Grupp

Authors
  1. Carsten Paul Bramlage
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  2. Britta Froelich
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  3. Manuel Wallbach
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  4. Joan Minguet
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  5. Clemens Grupp
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  6. Cornelia Deutsch
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  7. Peter Bramlage
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  8. Michael Koziolek
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  9. Gerhard Anton Müller
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Correspondence to Carsten Paul Bramlage.

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The study received ethical approval from the ethical commission of the university Goettingen (11/2/14AN) and was performed in accordance with the Declaration of Helsinki.

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Bramlage, C.P., Froelich, B., Wallbach, M. et al. The significance and predictive value of free light chains in the urine of patients with chronic inflammatory rheumatic disease. Clin Rheumatol 35, 2939–2946 (2016). https://doi.org/10.1007/s10067-016-3437-0

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  • DOI: https://doi.org/10.1007/s10067-016-3437-0

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