ab224012

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

L. Gossec, I. Bettembourg-Brault, T. Pham, M. Dougados

Service de Rhumatologie B, Université René Descartes, Centre Hospitalier Universitaire Cochin, Paris, France.

ABSTRACT
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. 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.

Conclusion
This study failed to demonstrate a relation between HLA phenotyping and the severity of RA defined by the requirement for surgery.

Key words
Rheumatoid arthritis, HLA-DR, prognosis, surgery.

Please address correspondence to: Dr. Laure Gossec, Service de Rhumatologie B, Centre Hospitalier Universitaire Cochin, 27, rue du faubourg Saint-Jacques, 75014 Paris, France.
E-mail: laure.gossec@cch.ap-hop-paris.fr

Please address reprint requests to: Pr. Maxime Dougados, Service de Rhumatologie B, Centre Hospitalier Universitaire Cochin, 27, rue du faubourg Saint-Jacques, 75014 Paris, France.
E-mail: maxime.dougados@cch.ap-hop-paris.fr