Association of HLA-DR4 with a more progressive disease course in patients with rheumatoid arthritis. Results of a followup study.
Association of HLA-DR4 with a more progressive disease course in patients with rheumatoid arthritis. Results of a followup study.
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HLA-DR4 与类风湿性关节炎患者病情进展的关系。
DOI：
10.1002/art.1780340707
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发表时间：
1991
影响因子：
--
通讯作者：
F. Breedveld
中科院分区：
文献类型：
--
作者：
D. van Zeben;J. Hazes;A. Zwinderman;A. Cats;G. Schreuder;J. D'Amaro;F. Breedveld
在一组具有良好特征的类风湿性关节炎(RA)患者队列中，研究了人类白细胞抗原-DR抗原与类风湿关节炎(RA)的相关性，这些患者从疾病开始就被跟踪(平均随访6年)。49例RA患者(n=49)的HLA-DR抗原频率与对照组相似。与正常对照组比较，明确RA组(n=134)DR1、DR4、DRV53等位基因频率升高，DR2、DR3、DRW6、DRV13、DRW52等位基因频率降低。根据疾病严重程度对明确类风湿关节炎患者进行随访期末的比较，发现DR4基因频率仅有差异，进展型类风湿性关节炎患者(59.2%)高于轻度类风湿性关节炎患者(34.8%)。进一步分析显示，与DR4阴性的RA患者相比，DR4阳性的患者关节肿胀更多，Ritchie关节指数、健康评估问卷和Steinbrocker功能分级得分更高，放射学异常更多，二线药物的使用更多。此外，DR4阳性患者的放射学异常进展率、功能分类和二线药物的使用情况也较高。我们得出结论，DR4与更严重的病程相关，并且是早期RA的预后标志。
The association between HLA-DR antigens and rheumatoid arthritis (RA) was investigated in a well-characterized cohort of RA patients who were followed from the beginning of the disease (mean followup 6 years). The frequencies of HLA-DR antigens in patients with possible or probable RA (n = 49) were similar to those in controls. In patients with definite RA (n = 134), the frequencies of DR1, DR4, and DRw53 were increased, whereas the frequencies of DR2, DR3, DRw6, DRw13, and DRw52 were decreased, compared with controls. Comparison of HLA-DR frequencies in patients with definite RA subclassified according to the severity of the disease at the end of the followup period revealed a difference only in the frequency of DR4, which was increased in patients with progressive RA (59.2%) compared with those who had mild RA (34.8%). Further analysis showed that, compared with DR4-negative RA patients, DR4-positive patients had more swollen joints, higher scores on the Ritchie articular index, the Health Assessment Questionnaire, and the Steinbrocker functional classification, more radiologic abnormalities, and more use of second-line drugs. Also, the rate of progression of radiologic abnormalities, functional classification, and use of second-line drugs was higher in DR4-positive patients. We conclude that DR4 is associated with a more severe disease course, and is a prognostic marker in early RA.