Prognostic markers of radiographic progression in early RA

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Arthritis Rheum. 2004 Jan; 50(1): 43-54.

Prognostic markers of radiographic progression in early rheumatoid

arthritis.

Goronzy JJ, Matteson EL, Fulbright JW, Warrington KJ, Chang- A,

Hunder GG, Mason TG, AM, Valente RM, Crowson CS, Erlich HA,

Reynolds RL, Swee RG, O'Fallon WM, Weyand CM.

Mayo Clinic, Rochester, Minnesota 55905, USA. goronzy.jorg@...

OBJECTIVE: To identify prognostic markers that are predictive of

progressive erosive disease in patients with early rheumatoid arthritis

(RA). METHODS: The study involved an inception cohort of 111 consecutive

patients with RA and a disease duration of <1 year. Patients were

treated according to an algorithm designed to avoid overtreatment of

mild disease and to accelerate treatment in patients who had continuous

disease activity. Patients were evaluated for the presence of clinical

and laboratory disease activity markers. We determined the frequency of

CD4+,CD28(null) T cells by flow cytometry, HLA-DRB1 gene polymorphisms

by polymerase chain reaction (PCR)/sequencing, and 26 single-nucleotide

polymorphisms in 19 candidate genes by multiplex PCR and hybridization

to an immobilized probe array. Data were analyzed using proportional

odds models to identify prognostic markers predictive of erosive

progression over 2 years on serial hand/wrist radiographs. RESULTS:

After 2 years, disease activity in 52% of the cohort was controlled by

treatment with hydroxychloroquine and nonsteroidal agents. Forty-eight

percent of the patients did not develop erosions. Older age, presence of

erosions at baseline, presence of rheumatoid factor, rheumatoid factor

titer, and HLA-DRB1*04 alleles, particularly homozygosity for

HLA-DRB1*04, were univariate predictors of radiographic progression.

Promising novel markers were the frequency of CD4+,CD28(null) T cells as

an immunosenescence indicator, and a polymorphism in the uteroglobin

gene.

CONCLUSION: Clinical disease activity in patients with early RA can

frequently be controlled with nonaggressive treatment, but this is not

always sufficient to prevent new erosions. Rheumatoid factor titer,

HLA-DRB1 polymorphisms, age, and immunosenescence markers are predictors

of poor radiographic outcome. A polymorphism in the uteroglobin gene may

identify patients who have a low risk of erosive disease.

PMID: 14730598

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Mayo Clinic in Rochester

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s Hopkins Medicine

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