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Protective effect of HLA-DRB1*13 alleles during specific phases in the development of ACPA-positive RA
  1. Jurgen van Heemst1,
  2. Aase H Hensvold2,
  3. Xia Jiang3,
  4. Hanna van Steenbergen1,
  5. Lars Klareskog2,
  6. Tom W J Huizinga1,
  7. Annette van der Helm-van Mil1,
  8. Anca I Catrina2,
  9. René E M Toes1,
  10. Karin Lundberg2,
  11. Diane van der Woude1
  1. 1Department of Rheumatology, Leiden University Medical Center, The Netherlands
  2. 2Department of Rheumatology, Karolinska Institutet, Stockholm, Sweden
  3. 3Department of Epidemiology, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Diane van der Woude, Department of Rheumatology C1-R, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, Leiden 2300 RC, The Netherlands; dvanderwoude{at}


Objective Human leucocyte antigen (HLA)-DRB1*13 alleles are associated with protection from anticitrullinated protein antibody (ACPA)-positive rheumatoid arthritis (RA). It is, however, unknown at which phase of disease development (seroconversion, ACPA maturation, disease onset or outcome) these alleles are most important. We therefore examined the effect of HLA-DRB1*13 on: ACPA presence (systemic autoimmunity associated with RA) in individuals with and without RA, on ACPA characteristics and on clinical outcome measures.

Methods The effect of HLA-DRB1*13 on ACPA presence in subjects with or without RA (non-RA) was assessed in the Swedish twin registry (n=10 748). ACPA characteristics were studied in patients with ACPA-positive RA from the Swedish Epidemiological Investigation of RA (EIRA, n=1224) and the Dutch Leiden Early Arthritis Clinic (EAC, n=441). Disease activity at inclusion and disease outcome (disease-modifying antirheumatic drugs (DMARD)-free sustained remission and radiographic progression) was assessed in patients with RA from the EAC.

Results HLA-DRB1*13 is associated with protection from ACPA-positive RA (prevalence 16% vs 28% in ACPA-negative non-RA), but not with significant protection from ACPA in individuals without RA (prevalence: 22%, p value 0.09). HLA-DRB1*13 is associated with lower ACPA-levels (EIRA: 447 U/ml versus 691 U/ml, p value= 0.0002) and decreased citrullinated epitope recognition (EIRA: p<0.0001). No association between HLA-DRB1*13 and disease activity or outcome was found.

Conclusions These data indicate that HLA-DRB1*13 mainly affects the onset of ACPA-positive RA in ACPA-positive non-RA individuals. In RA, HLA-DRB1*13 influences ACPA characteristics but not the disease course. This implies that therapeutic strategies aimed at emulating the HLA-DBR1*13 protective effect may be most effective in ACPA-positive healthy individuals at risk for RA.

  • Rheumatoid Arthritis
  • Gene Polymorphism
  • Ant-CCP
  • Autoantibodies
  • Early Rheumatoid Arthritis

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