Characterization of cumulative joint damage patterns in patients with rheumatoid arthritis: a clinical, serological, and gene polymorphism perspective

J Rheumatol. 2015 Mar;42(3):405-12. doi: 10.3899/jrheum.131177. Epub 2015 Feb 1.

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).

Conclusion: CJD patterns were associated with disease severity, HLA-DRB1 SE status, presence and titer of ACPA and RF, and morphometric features.

Keywords: ANTICITRULLINATED PROTEIN ANTIBODIES; DIAGNOSTIC IMAGING; JOINT EROSIONS; RHEUMATOID ARTHRITIS; RHEUMATOID FACTOR.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Alleles
  • Arthritis, Rheumatoid / blood
  • Arthritis, Rheumatoid / diagnostic imaging*
  • Arthritis, Rheumatoid / genetics
  • Autoantibodies / blood
  • Epitopes
  • Female
  • Foot Joints / diagnostic imaging*
  • Genetic Predisposition to Disease
  • Genotype
  • HLA-DRB1 Chains / genetics
  • Hand Joints / diagnostic imaging*
  • Humans
  • Male
  • Middle Aged
  • Polymorphism, Single Nucleotide*
  • Radiography
  • Rheumatoid Factor / blood
  • Young Adult

Substances

  • Autoantibodies
  • Epitopes
  • HLA-DRB1 Chains
  • Rheumatoid Factor