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This article is part of the supplement: Fourth International Synovitis Workshop

Meeting abstract

Immunogenetic Aspects of Disease Progression in Rheumatoid Arthritis

Ralf Wassmuth1, Sylke Kaltenhäuser2, Ulf Wagner2, Sybille Arnold2, Wolfram Seidel2, Michael Tröltsch2, Ernst Schuster3, Markus Löffler3, Joachim R Kalden1 and Holm Häntzschel2

Author affiliations

1 University of Erlangen-Nürnberg, Erlangen, Germany

2 University of Leipzig, Leipzig, Germany

3 Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany

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Citation and License

Arthritis Res 2000, 1(Suppl 1):S02-351  doi:10.1186/ar16

The electronic version of this article is the complete one and can be found online at: http://arthritis-research.com/15nov99/ar01s1


Published:15 November 1999

© 2000 Current Science Ltd

Full text

In an ongoing collaborative prospective study aimed at the identification of prognostic factors for the development of erosive disease and clinical severity of disease in early rheumatoid arthritis (RA) [1], 48 patients were followed for more than 4 years, and 87 patients were seen for 2 years. Significant associations with progressive joint destruction, measured by the Larsen index, were observed after 2 and 4 years for three parameters: 1) the presence of rheumatoid factor IgM; 2) bony erosions present at study entry, and 3) HLA DRB1 markers. Patients who expressed the shared epitope on a DR4 allele had significantly higher Larsen indices after 2 years (0.86 vs 0.12; P = 0.0015) and after 4 years (1.22 vs 0.53; P = 0.002) of disease duration. Similarly, the presence of the epitope sequence on either DR1 or DR4 also resulted in higher Larsen indices for epitope-positive patients (0.59 vs 0.06; P = 0.006 after 2 years, and 1.0 vs 0.69; P = 0.03 after 4 years). A more severe radiologic outcome after 2 years (Larsen index > 0.7) was detected with a sensitivity of 0.7, 0.61, and 0.58 and a specificity of 0.42, 0.84 and 0.75 using RF IgM, erosiveness at initial presentation, and presence of the shared epitope on a DR4 as prognostic parameters. Most useful, however, was the combination of DR4 positivity and erosiveness at study entry as prognostic indicators of a more severe course of joint destruction (sensitivity 0.68; specificity 0.77).

In summary, seropositivity, early erosiveness, and RA-associated HLA-DRB1 markers are useful prognostic indicators of the progression of joint destruction. Moreover, this influence is sustained during the first four years of the course of the disease.

References

  1. Wagner U, Kaltenhauser S, Sauer H, et al.: HLA markers and prediction of clinical course and outcome in rheumatoid arthritis.

    Arthritis Rheum 1997, 40:341-351. PubMed Abstract OpenURL