Adult seronegative arthritis with antinuclear antibodies: a distinct group of patients with a different immunogenetic pattern from seropositive rheumatoid arthritis and a good outcome.
To determine whether patients with rheumatoid factor (RF)-negative, antinuclear antibody (ANA)-positive oligo/polyarthritis are clinically and immunogenetically distinct from RF-positive rheumatoid arthritis (RA) and whether this subset of patients is the adult counterpart of early-onset pauciarticular juvenile chronic arthritis (EOPA JCA), we retrospectively studied 20 adult patients with RF-negative, ANA-positive arthritis. After a median duration of 3.25 years, only half of our patients had active synovitis. Seventy-five per cent were completely or reasonably self-sufficient according to the HAQ index. In contrast to the results in a group of 30 RF-positive RA patients, the percentage of patients having at least one of the susceptibility alleles (HLA DR1 or HLA-DR4) was not significantly higher in patients with RF-negative, ANA-positive arthritis than in controls. Furthermore, none of our RF-negative, ANA-positive patients had two susceptibility alleles, whereas 16.5% of RF-positive RA patients had both DR1 and DR4 or DR4 homozygosity. In conclusion, our results show that patients with RF-negative, ANA-positive oligo/polyarthritis are immunogenetically distinct from RF-positive RA and tend to have a better articular prognosis. The absence of typical ocular features and of the characteristic HLA-DR markers suggests that these patients cannot be considered as the adult counterpart of EOPA JCA.
Saudan-Kister
A
A
Division de Rhumatologie, Hôpital Cantonal Universitaire de Genève, Switzlerand.
Gabay
C
C
Tiercy
J M
JM
Mermillod
B
B
Guerne
P A
PA
Vischer
T L
TL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000483:Alleles; D000974:Antibodies, Antinuclear / Q000032:analysis*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001168:Arthritis / Q000188:drug therapy / Q000235:genetics* / Q000276:immunology*; D001172:Arthritis, Rheumatoid / Q000235:genetics* / Q000276:immunology*; D015331:Cohort Studies; D005260:Female; D006684:HLA-DR Antigens / Q000032:analysis / Q000235:genetics; D059811:HLA-DRB1 Chains; D006801:Humans; D007125:Immunogenetics; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012217:Rheumatoid Factor / Q000032:analysis*; D016896:Treatment Outcome
D000974:Antibodies, Antinuclear; D018501:Antirheumatic Agents; D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains; D012217:Rheumatoid Factor