Open AccessThe influence of HLA–DRB1 alleles and rheumatoid factor on disease outcome in an inception cohort of patients with early inflammatory arthritis
Author(s) -
Harrison Beverley,
Thomson Wendy,
Symmons Deborah,
Ollier Bill,
Wiles Nicola,
Payton Tony,
Barrett Elizabeth,
Silman Alan
Publication year - 1999
Publication title -
arthritis & rheumatism
Language(s) - English
Resource type - Journals
eISSN - 1529-0131
pISSN - 0004-3591
DOI - 10.1002/1529-0131(199910)42:10<2174::aid-anr19>3.0.co;2-g
Subject(s) - medicine , rheumatoid arthritis , hla drb1 , allele , rheumatoid factor , arthritis , polyarthritis , relative risk , disease , human leukocyte antigen , immunology , population , prospective cohort study , cohort , confidence interval , genetics , antigen , biology , environmental health , gene
Objective There are conflicting data concerning the role of HLA–DRB1 alleles in disease outcome in early rheumatoid arthritis. The exact role of these alleles in short‐term outcome is determined in this large, prospective, population‐based study. Methods We recruited 532 patients with inflammatory polyarthritis from the Norfolk Arthritis Register and typed their sera for HLA–DRB1 alleles using polymerase chain reaction–based methods. Disease outcome was assessed at 2 years in terms of persistent joint inflammation, functional disability, and radiologic erosions. Results are expressed as risk ratios (RR) with 95% confidence intervals (95% CI). Results There was no influence of HLA–DRB1 alleles, in any combination, on the likelihood of disease persistence, and only a modest effect on functional disability (Health Assessment Questionnaire score ≥1). The most obvious effect was on the development of erosions (RR 1.9, 95% CI 1.4–2.6 for those who carried at least 1 DRB1 shared epitope [SE] allele), with slightly greater effects for those who were homozygous for SE‐bearing alleles (RR 2.5, 95% CI 1.8–3.6). This effect of HLA–DRB1 was restricted to patients whose sera were negative for rheumatoid factor. Among patients with erosions, HLA–DRB1 had no influence on the severity of radiologic damage (defined as the number of eroded joints, or total Larsen score). Conclusion These data do not support routine HLA–DRB1 screening of patients with early arthritis to identify those at risk for subsequent severe disease.