title: The association between HLA genes and radiological erosions in Malaysian patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To assess the relationship between the HLA-DRB1 genes with disease severity as assessed by radiological erosions in Malaysian patients with rheumatoid arthritis (RA).
  
  
  METHODS
  In this cross-sectional study, we studied 61 RA patients who fulfilled the ACR criteria for the diagnosis of RA. HLA-DRB1 genotyping was performed by sequence specific primer (SSP) - PCR. Radiological grading and erosive score of the hands and wrists was calculated according to the Larsen-Dale method. Demographic data and treatment given to the patients were obtained from their case records.
  
  
  RESULTS
  Fifty-six females and five males were studied from three ethnic groups. In 57 patients with erosions, rheumatoid factor was detected in 80%, HLA-DR4 in 40%, HLA-DRB1*0405 in 24% and shared epitope (SE) in 31%. The median delay in starting DMARDs was 24 months. The presence of rheumatoid factor, HLA-DR4 and HLA-DRB1*0405 were not significantly associated with a worse erosive score. Patients who possessed the SE had a higher erosive scores, compared to those who did not (p = 0.05). Concurrently, a delay in starting DMARD was associated with a high erosive score (p = 0.023, r = 0.348). However, after adjustment for the delay in starting DMARD, SE was no longer significantly associated with the erosive score.
  
  
  CONCLUSIONS
  In these patients, the delay in starting DMARDs had a greater influence on the erosive score than SE alone. Whilst we cannot discount the contribution of the SE presence, we would advocate early usage of DMARDs in every RA patient to reduce joint erosions and future disability.
authors: Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. yeapss@myjaring.net
authors: S S
authors: SS
authors: Yeap
authors: A
authors: A
authors: Mohd
authors: G
authors: G
authors: Kumar
authors: K F
authors: KF
authors: Kong
authors: S K
authors: SK
authors: Chow
authors: E M L
authors: EM
authors: Goh
authors: M E
authors: ME
authors: Phipps
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000235:genetics* / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D006684:HLA-DR Antigens / Q000235:genetics*; D059811:HLA-DRB1 Chains; D006801:Humans; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D011859:Radiography
chemical_list: D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains