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  • Genotyping for disease associated HLA DR β1 alleles and the need for early joint surgery in rheumatoid arthritis: a quantitative evaluation

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Genotyping for disease associated HLA DR β1 alleles and the need for early joint surgery in rheumatoid arthritis: a quantitative evaluation
  1. Anne Crilly,
  2. Nicola Maiden,
  3. Hilary A Capell,
  4. Rajan Madhok
  1. University Department of Medicine, Glasgow Royal Infirmary and Centre For Rheumatic Diseases, Glasgow Royal Infirmary, Glasgow
  1. Dr R Madhok, Centre For Rheumatic Disease, Glasgow Royal Infirmary, University and NHS Trust, 84 Castle Street, Glasgow G4 OSF.

Abstract

OBJECTIVE To determine the value of HLA DR β1 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 β1 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%), χ2 = 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 hv 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.

  • HLA DR β1
  • erythrocyte sedimentation rate
  • rheumatoid arthritis

https://doi.org/10.1136/ard.58.2.114

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