Extended reports
HLA-DRB1 alleles associated with polymyalgia rheumatica in
northern Italy: correlation with disease severity
a Servizio di
Reumatologia, Arcispedale S Maria Nuova, Reggio Emilia, Italy, b Laboratorio Centralizzato, Settore Tipizzazione
Tissutale, Ospedale S Orsola-Malpighi, Bologna, Italy, c Cattedra di Biometria e Statistica Medica,
Istituto di Igiene, Università di Modena, Italy, d Unità
Reumatologica, Ospedale di Prato, Prato, Italy, e Unità di Reumatologia, Ospedale S Carlo,
Potenza, Italy
Correspondence to: Dr C Salvarani, Servizio di Reumatologia, Azienda Ospedaliera Arcispedale S Maria Nuova, V le Umberto 1 N50, 42100 Reggio Emilia, Italy.
Accepted for publication 15 February 1999
OBJECTIVE
To examine
the association of HLA-DRB1 alleles with polymyalgia rheumatica (PMR)
in a Mediterranean country and to explore the role of HLA-DRB1 genes in
determining disease severity.
METHODSA five year
prospective follow up study of 92 consecutive PMR patients diagnosed by
the secondary referral centre of rheumatology of Reggio Emilia, Italy
was conducted. HLA-DRB1 alleles were determined in the 92 patients, in
29 DR4 positive rheumatoid arthritis (RA) patients, and in 148 controls
from the same geographical area by polymerase chain reaction
amplification and oligonucleotide hybridisation.
RESULTSNo significant
differences were observed in the frequencies of HLA-DRB1 types and in
the expression of HLA-DRB 70-74 shared motif between PMR and controls.
The frequency of the patients with double dose of epitope was low and
not significantly different in PMR and in controls. No significant
differences in the distribution of HLA-DR4 subtypes were observed
between DR4+ PMR, DR+ RA, and DR4+ controls. Results of the univariate
analysis indicated that an erythrocyte sedimentation rate (ESR) at
diagnosis > 72 mm 1st h, the presence of HLA-DR1, DR10, rheumatoid
epitope, and the type of rheumatoid epitope were significant risk
factors associated with relapse/recurrence. Cox proportional hazards
modelling identified two variables that independently increased the
risk of relapse/recurrence: ESR at diagnosis > 72 mm 1st h (RR=1.5)
and type 2 (encoded by a non-DR4 allele) rheumatoid epitope (RR=2.7).
CONCLUSIONThese data
from a Mediterranean country showed no association of rheumatoid
epitope with PMR in northern Italian patients. A high ESR at diagnosis
and the presence of rheumatoid epitope encoded by a non-DR4 allele are
independent valuable markers of disease severity.
© 1999 by Annals of the Rheumatic Diseases
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