HLA DRB1*01 and DRB1*04 phenotyping does not predict the need for joint surgery in rheumatoid arthritis. A retrospective quantitative evaluation of 300 French patients.
OBJECTIVE
To determine if the presence of HLA-DR disease-associated epitopes predicts the need for total joint arthroplasty or joint fusion in rheumatoid arthritis (RA).


METHODS
Tertiary-referral, monocenter study. Three hundred RA patients (1987 ACR criteria) were retrospectively evaluated; outcome measure was recourse to total joint arthroplasty, joint fusion or bone resection. HLA-DR1 and DR4 were considered as the disease-associated epitopes (subtypes were not available for analysis). Analysis was performed using the lifetable method (Kaplan-Meyer technique).


RESULTS
Of the 300 patients included, 78% were women, mean age: 56+/-14 years, mean RA follow-up: 12+/-9 years. Phenotyping: 73% of patients carried one (52%) or two (21%) disease-associated epitopes. Surgery was performed on 24% of the patients during follow-up. The most frequent surgery was total hip arthroplasty (13% of patients). According to lifetable analysis, 13% of patients had surgery (total joint arthroplasty or joint fusion) after 10 years of follow-up, 34% after 20 years. years of follow-up, There was no statistically significant difference in recourse to surgery according to absence or presence (single or double-dose) of disease-associated epitopes. Similar results were observed if the event was the second surgical procedure on a given patient.


CONCLUSIONS
This study failed to demonstrate a relation between HLA phenotyping and the severity of RA defined by the requirement for surgery.
Service de Rhumatologie B, Université René Descartes, Centre Hospitalier Universitaire Cochin, Paris, France. laure.gossec@cch.ap-hop-paris.fr
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Gossec
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Bettembourg-Brault
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Pham
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Dougados
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000235:genetics / Q000276:immunology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D020022:Genetic Predisposition to Disease; D006684:HLA-DR Antigens / Q000235:genetics*; D059811:HLA-DRB1 Chains; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D010045:Outpatients; D011237:Predictive Value of Tests; D012189:Retrospective Studies
D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains