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Background  We evaluated the significance of the genes, defined as  DRB1*04  or  DRB1*01 , in rheumatoid arthritis (RA) patients. We focused on the role of genetic and serologic markers to predict disease activity and destructive process of joints.    Methods  Sixty patients with RA were examined. Radiographic changes were evaluated by (Larsen score) and disease activity was measured by disease activity score 28 (DAS28). The markers analyzed were: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptides (anti-CCP2) and HLA- DRB1  alleles typed by PCR.    Results  In this study, anti-CCP antibodies, CRP, RF and AKA were detected in 83.3%, 56.7%, 71.7% and 52% of patients respectively. HLA- DRB1 *01 was found in 45% of patients and 35% of them had one or two HLA- DRB1*04  alleles. According to  DRB1*04  subtypes, ( DRB1* 0405 ) was present in of 80% them. For prediction of grade of activity, the independent predictors were anti-CCP (OR 19.6), and  DRB1*04  positive allele (OR 5.1). The combination of  DRB1*04  + anti-CCP antibodies gave increase in the specificity and positive predictive value to 92% and 90 respectively. As regards to the prediction of radiological joint damage, the independent predictors were HLA- DRB1*04 , HLA- DRB1*01 , RF, and CRP > 18 (OR 5.5, 4.5, 2.5, 2.0 respectively).    Conclusion  Our findings suggest that anti-CCP2 is superior to RF for the detection of RA and provided predictive information on joint destruction and disease activity. The presence of RA associated antibodies (ACCP or RF) and/or the SE genes are indicative for a poorer radiological outcome and higher grade of activity.

international archives of medicine

Diagnostic performance and predictive value of rheumatoid factor, anti-cyclic-citrullinated peptide antibodies and HLA-DRB1 locus genes in rheumatoid arthritis