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Preventing joint destruction is one of the challenges in rheumatoid arthritis (RA).1 Presence of two antibodies, namely, rheumatoid factor (RF) and cyclic citrullinated peptide antibodies (CCPs), is one of the major correlates of joint destruction.2 We recently showed the association between the progression of joint destruction and HLA-DRB1*04:05, which is independent from CCP positivity.3 HLA-DRB1*04:05 is one of shared epitope (SE) allele carrying common amino acid sequences at position 70–74 frequently found in Japanese and rarely observed in Europeans. Importantly, we showed that SE alleles other than DRB1*04:05 did not show independent associations from CCP.3
Based on the unique characteristics of HLA-DRB1*04:05, we hypothesised that HLA-DRB1*04:05 might lead to high disease activity not fully captured by Disease Activity Acore 28 (DAS28) and that it independently of DAS28 determines radiographic progression in patients with anti-CCP-positive RA (figure 1A).
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