title: Characterization of cumulative joint damage patterns in patients with rheumatoid arthritis: a clinical, serological, and gene polymorphism perspective.
abstract: OBJECTIVE
  To characterize cumulative joint damage (CJD) patterns in rheumatoid arthritis (RA) and determine their associations with demographic/clinical features and HLA-DRB1 gene polymorphism.
  
  
  METHODS
  Hand and foot radiographs were obtained from 404 patients with RA. CJD patterns were determined by 3 derivations from Sharp/van der Heijde scores, obtained by the mathematical division of scores for hands/feet (Sharp-h/f score), fingers/wrists (Sharp-f/w score), and erosion/space narrowing (Sharp-e/sn score), respectively. DNA and serum were obtained for determination of HLA-DRB1 polymorphism, rheumatoid factor (RF), and anticitrullinated protein antibodies (ACPA).
  
  
  RESULTS
  Patients with wrist-dominant CJD pattern were more likely to have severe RA than those with finger-dominant pattern (68.4% vs 46.0%; p = 0.036) as were those with foot-dominant vs hand-dominant CJD pattern (76.5% vs 56.4%; p = 0.044). HLA-DRB1 shared epitope (SE) alleles were associated with erosion-dominant CJD pattern (p = 0.021). Patients with erosion-dominant CJD pattern had higher levels of RF and ACPA than those with space-narrowing-dominant CJD pattern (median RF 71.35 U/ml vs 22.05 U/ml, respectively; p = 0.003; median ACPA 187.9 U/ml vs 143.2 U/ml, respectively; p < 0.001). The majority of triple-positive patients (SE+, RF+, ACPA+) had erosion-dominant CJD pattern (62.3%) while the majority of triple-negative patients (SE-, FR-, ACPA-) had space narrowing-dominant CJD pattern (75%; p = 0.017). ACPA was associated with HLA-DRB1 SE alleles (p < 0.05). Patients with foot-dominant CJD pattern were taller than those with hand-dominant CJD pattern (p = 0.002); those with erosion-dominant CJD pattern had higher weight and body mass index than those with space narrowing-dominant CJD pattern (p = 0.014, p = 0.001).
  
  
  CONCLUSIONS
  CJD patterns were associated with disease severity, HLA-DRB1 SE status, presence and titer of ACPA and RF, and morphometric features.
authors: From the Rheumatology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo; Rheumatology Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro; Rheumatology Division, Universidade de São Paulo (USP); Rheumatology Division, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil.Dr. Alarcon received an academic grant from CAPES (Brazilian Agency for Scientific Development) and Dr. Andrade receives a research grant from CNPq (Brazilian Agency for Research Development). Partially supported by grant # 07/50523-9 from the São Paulo Research Foundation.R.T. Alarcon, PhD, Research Fellow, Biol.; A.R.C. Fernandes, MD, PhD, Associate Professor, UNIFESP; I.M. Laurindo, MD, PhD, Associate Researcher, USP; M.B. Bértolo, MD, PhD, Associate Professor, UNICAMP; G.C. Pinheiro, MD, PhD, Associate Professor, UERJ; L.E. Andrade, MD, PhD, Associate Professor, UNIFESP.
authors: Renata Trigueirinho
authors: RT
authors: Alarcon
authors: From the Rheumatology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo; Rheumatology Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro; Rheumatology Division, Universidade de São Paulo (USP); Rheumatology Division, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil.Dr. Alarcon received an academic grant from CAPES (Brazilian Agency for Scientific Development) and Dr. Andrade receives a research grant from CNPq (Brazilian Agency for Research Development). Partially supported by grant # 07/50523-9 from the São Paulo Research Foundation.R.T. Alarcon, PhD, Research Fellow, Biol.; A.R.C. Fernandes, MD, PhD, Associate Professor, UNIFESP; I.M. Laurindo, MD, PhD, Associate Researcher, USP; M.B. Bértolo, MD, PhD, Associate Professor, UNICAMP; G.C. Pinheiro, MD, PhD, Associate Professor, UERJ; L.E. Andrade, MD, PhD, Associate Professor, UNIFESP.
authors: Artur da Rocha Corrêa
authors: Ada R
authors: Fernandes
authors: From the Rheumatology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo; Rheumatology Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro; Rheumatology Division, Universidade de São Paulo (USP); Rheumatology Division, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil.Dr. Alarcon received an academic grant from CAPES (Brazilian Agency for Scientific Development) and Dr. Andrade receives a research grant from CNPq (Brazilian Agency for Research Development). Partially supported by grant # 07/50523-9 from the São Paulo Research Foundation.R.T. Alarcon, PhD, Research Fellow, Biol.; A.R.C. Fernandes, MD, PhD, Associate Professor, UNIFESP; I.M. Laurindo, MD, PhD, Associate Researcher, USP; M.B. Bértolo, MD, PhD, Associate Professor, UNICAMP; G.C. Pinheiro, MD, PhD, Associate Professor, UERJ; L.E. Andrade, MD, PhD, Associate Professor, UNIFESP.
authors: Ieda Maria
authors: IM
authors: Laurindo
authors: From the Rheumatology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo; Rheumatology Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro; Rheumatology Division, Universidade de São Paulo (USP); Rheumatology Division, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil.Dr. Alarcon received an academic grant from CAPES (Brazilian Agency for Scientific Development) and Dr. Andrade receives a research grant from CNPq (Brazilian Agency for Research Development). Partially supported by grant # 07/50523-9 from the São Paulo Research Foundation.R.T. Alarcon, PhD, Research Fellow, Biol.; A.R.C. Fernandes, MD, PhD, Associate Professor, UNIFESP; I.M. Laurindo, MD, PhD, Associate Researcher, USP; M.B. Bértolo, MD, PhD, Associate Professor, UNICAMP; G.C. Pinheiro, MD, PhD, Associate Professor, UERJ; L.E. Andrade, MD, PhD, Associate Professor, UNIFESP.
authors: Manoel Barros
authors: MB
authors: Bértolo
authors: From the Rheumatology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo; Rheumatology Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro; Rheumatology Division, Universidade de São Paulo (USP); Rheumatology Division, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil.Dr. Alarcon received an academic grant from CAPES (Brazilian Agency for Scientific Development) and Dr. Andrade receives a research grant from CNPq (Brazilian Agency for Research Development). Partially supported by grant # 07/50523-9 from the São Paulo Research Foundation.R.T. Alarcon, PhD, Research Fellow, Biol.; A.R.C. Fernandes, MD, PhD, Associate Professor, UNIFESP; I.M. Laurindo, MD, PhD, Associate Researcher, USP; M.B. Bértolo, MD, PhD, Associate Professor, UNICAMP; G.C. Pinheiro, MD, PhD, Associate Professor, UERJ; L.E. Andrade, MD, PhD, Associate Professor, UNIFESP.
authors: Geraldo Castelar
authors: GC
authors: Pinheiro
authors: From the Rheumatology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo; Rheumatology Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro; Rheumatology Division, Universidade de São Paulo (USP); Rheumatology Division, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil.Dr. Alarcon received an academic grant from CAPES (Brazilian Agency for Scientific Development) and Dr. Andrade receives a research grant from CNPq (Brazilian Agency for Research Development). Partially supported by grant # 07/50523-9 from the São Paulo Research Foundation.R.T. Alarcon, PhD, Research Fellow, Biol.; A.R.C. Fernandes, MD, PhD, Associate Professor, UNIFESP; I.M. Laurindo, MD, PhD, Associate Researcher, USP; M.B. Bértolo, MD, PhD, Associate Professor, UNICAMP; G.C. Pinheiro, MD, PhD, Associate Professor, UERJ; L.E. Andrade, MD, PhD, Associate Professor, UNIFESP. luis.andrade@unifesp.br.
authors: Luís Eduardo
authors: LE
authors: Andrade
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000483:Alleles; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging* / Q000235:genetics; D001323:Autoantibodies / Q000097:blood; D000939:Epitopes; D005260:Female; D033023:Foot Joints / Q000000981:diagnostic imaging*; D020022:Genetic Predisposition to Disease; D005838:Genotype; D059811:HLA-DRB1 Chains / Q000235:genetics; D050823:Hand Joints / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020641:Polymorphism, Single Nucleotide; D011859:Radiography; D012217:Rheumatoid Factor / Q000097:blood; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D000939:Epitopes; D059811:HLA-DRB1 Chains; D012217:Rheumatoid Factor
keywords: ANTICITRULLINATED PROTEIN ANTIBODIES; DIAGNOSTIC IMAGING; JOINT EROSIONS; RHEUMATOID ARTHRITIS; RHEUMATOID FACTOR