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

doi:10.1136/ard.58.2.114

Annals of the Rheumatic Diseases 1999;58:114-117; doi:10.1136/ard.58.2.114

Ann Rheum Dis 1999;58:114-117 ( February )

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Genotyping for disease associated HLA DR $beta$ 1 alleles and the need for early joint surgery in rheumatoid arthritis: a quantitative evaluation Anne Crilly, Nicola Maiden, Hilary A Capell, Rajan Madhok

University Department of Medicine, Glasgow Royal Infirmary and Centre For Rheumatic Diseases, Glasgow Royal Infirmary, Glasgow

Correspondence to: Dr R Madhok, Centre For Rheumatic Disease, Glasgow Royal Infirmary, University and NHS Trust, 84 Castle Street, Glasgow G4 OSF.

Accepted for publication 28 October 1998

OBJECTIVE $---$ To determine the value of HLA DR $beta$ 1 disease associated epitope (DAE) and erythrocyte sedimentation (ESR) in predicting theneed 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 hadnot. HLA DR $beta$ 1 genotype was determined by polymerase chain reaction.ESR at first hospital visit wasnoted.
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). Sensitivitywas poor, 32%, specificity high, 91%. Presentation ESR was higherin surgery patients compared with non-surgery patients, 52 mm1st 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 oneor no DAE, a high ESR is an importantpredictor.

Keywords: HLA DR $beta$ 1; erythrocyte sedimentation rate; rheumatoid arthritis

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