Naturally acquired adaptive immunity to is impaired in rheumatoid arthritis patients.

Objectives: Patients with rheumatoid arthritis (RA) have an increased susceptibility to infections, including those caused by . Why RA is associated with increased susceptibility to is poorly understood. This study aims to assess the effects of RA and B-cell depletion therapy on naturally acquired antibody responses to 289  protein antigens using a novel protein array.

Methods: IgG responses to were characterised in serum from RA patients and disease controls (myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)) using whole-cell ELISA, a flow cytometry opsonisation assay and an protein array. For the RA patients, results were compared before and after B-cell depletion therapy.

Results: Compared to a well-characterised disease control group of ME/CFS patients, RA patients had reduced antibody responses to multiple protein antigens, with significant IgG recognition of approximately half the number of antigens along with reduced median strengths of these responses. Reduction in multiple array antigen-specific responses also correlated with reduced IgG opsonisation of . Although B-cell depletion therapy with rituximab did not reduce overall IgG recognition of in the RA group, it was associated with marked disruption of pre-existing IgG repertoire to protein antigens in individual patients.

Conclusion: These data show RA is associated with major disruption of naturally acquired adaptive immunity to , which can be assessed rapidly using a protein antigen array and is likely to contribute towards the increased incidence of pneumonia in patients with RA.