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THU0161 Rheumatoid arthritis with antikeratin antibodies (aka): a distinct immunogenetic or prognostic subgroup?
  1. A Gómez1,
  2. R Sanmartí1,
  3. O Viñas2,
  4. G Ercilla2,
  5. JD Cañete1,
  6. C Orellana1,
  7. G Salvador1,
  8. J Muñoz-Gómez1
  1. 1Rheumatology
  2. 2Immunology, Hospital Clinic, Barcelona, Spain

Abstract

Background Antikeratin antibodies (AKA) have been described as the most specific serologic markers of RA. However, whether these antibodies can identify a particular RA population it remains controversial.

Objectives To compare the immunogenetic features (HLA-DRB1 and TNF-a polymorphism) and radiological severity of a group of patients with early RA, according to the presence or not of AKA.

Methods 65 patients with early RA (48F/17M, mean age: 50 ± 14 y, mean disease duration 15 ± 12 mo, RF+:71%) were genotyped for HLA-DRB1 and TNF-a alleles. Hands and feet x-ray were taken at entry and then yearly during follow-up. The Larsen method was used to assess radiographic damage. AKA was determined by immunofluorescence using a modified Young method (sensitivity/specificity 60.2%/98.3%).

Results AKA were present in the sera of 34 patients (prevalence of 52.3%). RF was more frequently found in AKA+ patients than in those without (85.3% vs. 54.8%; p = 0.007). No differences were observed according to the shared epitope and the frequency of HLA-DR4. The different TNF-a polymorphisms were equally distributed in AKA positive and negative populations. No significative radiological differences (presence of erosive disease and Larsen score) were observed at study entry between both populations. A trend to a more progressive radiological damage was observed at the end of follow-up.(32 ± 6 mo) in those patients with AKA, although the differences were no significative (Larsen score of 6.1 ± 4.3 in AKA(+) vs. 4.5 ± 5.5 in AKA (-). This trend is also observed when only RF positive patients were evaluated.

Conclusion These results indicate that AKA cannot identify a distinct immunogenetic subgroup in Spanish reumatoid population. The role of AKA as a possible marker of a more aggressive joint disease merits further investigation.

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