title: The influence of HLA-DRB1 alleles encoding the DERAA amino acid motif on radiological outcome in rheumatoid arthritis.
abstract: OBJECTIVE
  To investigate the influence of HLA-DRB1 alleles encoding the QK/RRAA shared epitope (SE) on radiological outcome in rheumatoid arthritis (RA), and to determine whether it is modulated by alleles carrying the putative rheumatoid arthritis-protective (RAP) sequence DERAA. Patients and methods. The association between erosive damage and HLA-DRB1 status was examined in 315 RA patients with a disease duration of 5-30 yr. Radiological outcome was measured by scoring X-rays of the hands and feet using the standard radiographs of Larsen (Larsen score). HLA-DRB1 typing was carried out using polymerase chain reaction methodology.
  
  
  RESULTS
  Patients with two alleles encoding the QK/RRAA SE had significantly higher Larsen scores than SE-negative patients (96.9 vs 83.3; P=0.04, after correction for multiple testing), with DRB1*0401/*0401 homozygotes demonstrating the greatest radiological damage (99.9). The lowest Larsen score (65.6) was observed in patients carrying the DERAA motif without an accompanying SE allele (RAP+/SE-). This was significantly lower than in patients with RAP+/SE+ (105.6; P=0.04), RAP-/SE- (88.2; P=0.05) and RAP-/SE+ (95.8; P=0.009), after correction for multiple testing. There was no evidence that the RAP sequence was modulating the effect of the SE since radiological outcome in RAP+/SE+ patients was not significantly different to that in RAP-/SE+ individuals.
  
  
  CONCLUSIONS
  Our data support a possible role for DRB1 alleles encoding the DERAA motif in protection against severe erosive damage in patients lacking the QK/RRAA SE, but not in patients heterozygous for the SE. This suggests that DRB1 alleles encoding the SE have a dominant influence over 'protective alleles' and are not merely 'non-protective'.
authors.affiliation: Staffordshire Rheumatology Centre, The Haywood, High Lane, Burslem, UK.
authors.forename: D L
authors.initials: DL
authors.lastname: Mattey
authors.forename: A B
authors.initials: AB
authors.lastname: Hassell
authors.forename: M J
authors.initials: MJ
authors.lastname: Plant
authors.forename: N T
authors.initials: NT
authors.lastname: Cheung
authors.forename: P T
authors.initials: PT
authors.lastname: Dawes
authors.forename: P W
authors.initials: PW
authors.lastname: Jones
authors.forename: W
authors.initials: W
authors.lastname: Thomson
authors.forename: K V
authors.initials: KV
authors.lastname: Poulton
authors.forename: A H
authors.initials: AH
authors.lastname: Hajeer
authors.forename: W E
authors.initials: WE
authors.lastname: Ollier
mesh_terms: D000483:Alleles; D020816:Amino Acid Motifs; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000235:genetics*; D000939:Epitopes / Q000235:genetics; D005260:Female; D005819:Genetic Markers; D006684:HLA-DR Antigens / Q000235:genetics*; D059811:HLA-DRB1 Chains; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010641:Phenotype; D011487:Protein Conformation; D011859:Radiography
chemical_list: D000939:Epitopes; D005819:Genetic Markers; D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains; C553505:HLA-DRB1*04:01 antigen