R. Rau et al., The effect of HLA-DRB1 genes, rheumatoid factor, and treatment on radiographic disease progression in rheumatoid arthritis over 6 years, J RHEUMATOL, 27(11), 2000, pp. 2566-2575
Objective. To investigate the relationship between radiographic disease pro
gression in the presence or absence of rheumatoid arthritis (RA) linked HLA
-DRB1 alleles after early introduction of disease modifying antirheumatic d
rug therapy in patients with RA over a study period of 6 years.
Methods. One hundred nine patients of a trial comparing intramuscular(im) g
old sodium thiomalate (GSTM) and im methotrexate (MTX) in early erosive RA
were followed for 6 years with regular assessments of clinical and laborato
ry data and yearly radiographs of hands and feet, and they were typed for H
LA-DRB1 genes. Radiographic progression was analyzed for an influence of rh
eumatoid factor (RF) status and HLA-DRB1 genes.
Results. Twenty-seven patients (25%) were positive for two. 46 (42%) for on
e, and 36 (33%) for none of the disease linked alleles. A decrease of the r
ate of radiographic disease progression with treatment in this group of pat
ients was reflected by the decline in the slope of the radiographic score.
Seropositive patients (n = 71, 68%) had a significantly more destructive di
sease course than RF negative patients. In seropositive disease, patients w
ith a "double dose" of RA linked alleles showed a tendency to greater progr
ession during the First 12-24 mo of treatment. but no significant differenc
e in the longterm radiographic outcome could be detected between subgroups
defined by the presence or absence of HLA-DRB1 genes. There was no signific
ant difference throughout the study period with respect to the clinical dis
ease course as assessed by joint swelling, C-reactive protein, and erythroc
yte sedimentation rate. The majority of the seronegative population (n = 38
, 32%) had a benign disease course with the exception of patients (n = 6) w
ith the double allele; they had radiographic disease progression comparable
with the seropositive patients.
Conclusion. Our data do not provide evidence fur a more aggressive disease
course in patients bearing double RA linked HLA-DRB1 alleles.