Immunoglobulin G glycosylation and clinical outcome in rheumatoid arthritis during pregnancy

J Rheumatol. 2000 Jun;27(6):1379-85.


Objective: To determine whether clinical outcome during pregnancy in rheumatoid arthritis (RA) is associated with changes in the levels of exposed immunoglobulin G (IgG) terminal sugars.

Methods: Serum IgG glycosylation from 23 pregnant patients with RA was analyzed during the prenatal, antenatal, and post-partum periods. Patients were randomly selected on the basis of whether they achieved spontaneous remission (n = 11) or did not remit (n = 12); of the latter group 6 patients experienced a relapse in disease activity. Levels of exposed terminal IgG sugars, galactose (Gal), N-acetylglucosamine (GlcNAc), and sialic acid (SA), were estimated in a lectin binding assay using Ricinis (communis, Bandeiraea simplicifolia II, and Sambucus nigra, respectively.

Results: Exposed Gal levels increased (p<0.02) and GlcNAc levels decreased (p<0.05) in the antenatal period, and returned to preconception levels during post-partum. GlcNAc rebound was instantaneous (p<0.005), whereas Gal remained high for a further 10 weeks. SA did not undergo any major changes. Remission was associated with an earlier and significantly greater antenatal reduction in GlcNAc (2nd and 3rd trimester; p<0.02) in comparison to the groups that did not experience a decrease in disease activity. Analysis of individual IgG samples during the first trimester revealed a significant negative correlation between Gal and GlcNAc in the remission group (r = -0.80; p<0.05), which was opposite to that found in the relapse group (r = +0.87; p<0.03). There was no significant difference between the groups with regard to the timing and/or incidence of a post-partum flare of disease.

Conclusion: Temporal changes in the levels of IgG terminal sugars, in particular exposed GlcNAc, are integrally associated with the clinical manifestation of RA in pregnancy. Generation of IgG sugar micro-heterogeneity is complex and understanding it may help unravel pathogenic features associated with RA.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetylglucosamine / immunology
  • Acetylglucosamine / metabolism
  • Adult
  • Arthritis, Rheumatoid / immunology*
  • Arthritis, Rheumatoid / metabolism*
  • Case-Control Studies
  • Female
  • Galactose / immunology
  • Galactose / metabolism
  • Glycosylation
  • Humans
  • Immunoglobulin G / immunology
  • Immunoglobulin G / metabolism*
  • Lectins
  • N-Acetylneuraminic Acid / immunology
  • N-Acetylneuraminic Acid / metabolism
  • Oligosaccharides / immunology
  • Oligosaccharides / metabolism
  • Pregnancy
  • Pregnancy Complications / immunology*
  • Pregnancy Complications / metabolism*
  • Prospective Studies
  • Remission, Spontaneous


  • Immunoglobulin G
  • Lectins
  • Oligosaccharides
  • N-Acetylneuraminic Acid
  • Acetylglucosamine
  • Galactose