Expression of RAG1, RAG2, and TdT in Rheumatoid Arthritis Synovia Evidence for Receptor Revision of Immunoglobulin Light Chains.docVIP

/supplements/1/S1 Abstracts Abstracts presented at the Fourth International Synovitis Workshop Dallas, Texas, 21–25 April 1999 Peter E Lipsky (Organizer), Simmons Arthritis Research Center Genetics of Rheumatoid Arthritis Genetics of Rheumatoid Arthritis than 4 years, and 87 patients were seen for 2 years. Significant associations with progressive joint destruction, measured by the Larsen index, were observed after 2 and 4 years for three parameters: 1) the presence of rheumatoid factor IgM; 2) bony erosions present at study entry, and 3) HLA DRB1 markers. Patients who expressed the shared epitope on a DR4 allele had significantly higher Larsen indices after 2 years (0.86 vs 0.12; P=0.0015) and after 4 years (1.22 vs 0.53; P=0.002) of disease duration. Similarly, the presence of the epitope sequence on either DR1 or DR4 also resulted in higher Larsen indices for epitope-positive patients (0.59 vs 0.06; P=0.006 after 2 years, and 1.0 vs 0.69; P=0.03 after 4 years). A more severe radiologic outcome after 2 years (Larsen index 0.7) was detected with a sensitivity of 0.7, 0.61, and 0.58 and a specificity of 0.42, 0.84 and 0.75 using RF IgM, erosiveness at initial presentation, and presence of the shared epitope on a DR4 as prognostic parameters. Most useful, however, was the combination of DR4 positivity and erosiveness at study entry as prognostic indicators of a more severe course of joint destruction (sensitivity 0.68; specificity 0.77). Gerald T Nepom Virginia Mason Research Center, Seattle, Washington, USA Genetic associations between rheumatoid arthritis and specific HLA class II genes provide clues to understanding the molecular basis for disease susceptibility. There is a remarkable structural relationship among different rheumatoid arthritis (RA) susceptibility genes, in which each of the associated class II alleles encodes a sequence