Genotyping for disease associated HLA DR beta 1 alleles and the need for early joint surgery in rheumatoid arthritis: a quantitative evaluation.

Abstract

OBJECTIVE:

To determine the value of HLA DR beta 1 disease associated epitope (DAE) and erythrocyte sedimentation (ESR) in predicting the need for major joint replacement in rheumatoid arthritis (RA).

METHODS:

Sixty five RA patients who had undergone hip, knee or shoulder arthroplasty within 15 years of disease onset and 65 who had not. HLA DR beta 1 genotype was determined by polymerase chain reaction. ESR at first hospital visit was noted.

RESULTS:

Significantly more patients with two DAE required surgery, (32% v 9%), chi 2 = 13.9, p = 0.001, odds ratio = 5.4 (95% CI: 1.8, 16). Sensitivity was poor, 32%, specificity high, 91%. Presentation ESR was higher in surgery patients compared with non-surgery patients, 52 mm 1st h v 25 mm 1st h, p < 0.001, but was independent of DAE status. Sensitivity of an ESR of 30 mm 1st h was 75%, specificity 53%.

CONCLUSION:

The presence of two DAE is a risk factor for major joint surgery in RA and is independent of ESR, whereas in those with one or no DAE, a high ESR is an important predictor.

• Authors: A Crilly, N Maiden, H A Capell, R Madhok
• Journal: Annals of the rheumatic diseases (Ann Rheum Dis) Vol. 58 Issue 2 Pg. 114-7 (Feb 1999) ISSN: 0003-4967 [Print] England
• PMID: 10343527 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Epitopes
• HLA-DR Antigens
• HLA-DRB1 Chains

Topics

• Aged
• Alleles
• Arthritis, Rheumatoid (blood, genetics, immunology, surgery)
• Arthroplasty
• Blood Sedimentation
• Case-Control Studies
• Epitopes (genetics)
• Female
• Genotype
• HLA-DR Antigens (genetics)
• HLA-DRB1 Chains
• Humans
• Male
• Middle Aged
• Polymerase Chain Reaction
• Predictive Value of Tests
• Risk Factors
• Sensitivity and Specificity