Pronostic factors in rheumatoid arthritis (RA)
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文摘
Clinical and biological profiles at the onset of RA and HLA typing were retrospectively studied in 2 groups of 94 patients with severe (group 1) or limited (group 2) articular damage based on radiological abnormalities. The two groups were matched according to the disease duration (mean: 8.1 yr). In a previous pilot analysis we demonstrated that ESR, CRP and HLA markers were the most relevant independent variables and could indicate the outcome in early RA. Particularly, 96 % of group 1 patients were DRB1*0401, 0404 or 01 as compared to 55 % in group 2 and 37 % in controls. Genotypes with double dose of RA-susceptible DRB1 alleles were detected in 34 % group 1 patients compared to 8.5 % in group 2 and 8 % in controls. In the present analysis, combining epidemiological, biostatistical and genetic approaches, we first categorized patients according to clinical and biological parameters. We then estimate the genetic risk for each category by comparing the distribution of the HLA genotypes. Using MASC analysis, we propose a model for the impact of the HLA component in the progression of RA. Thus specific forms of RA are associated with particular clinical, biological and genetic profiles, some of these factors being able to serve as pronostic tools for outcome at the onset of RA.