Immunogenetic heterogeneity of seronegative rheumatoid arthritis and the antiperinuclear factor

Article Abstract:

Individuals have various types of histocompatibility (HLA) antigens, which are proteins that allow the immune system to distinguish between foreign and non-foreign molecules and to respond accordingly. Individuals who have certain types of HLA molecules have a greater chance of developing certain diseases. Individuals with HLA-DR4 have a predisposition to adult-onset rheumatoid arthritis (RA). There are clinical subgroups of RA that do or do not have rheumatoid factor (RF), antibodies against a group of proteins known as globulins. The subgroups can be further divided based on the presence or absence of antiperinuclear factor (APF). Individuals with APF have antibodies to granules around the nucleus of cells; people who are APF-positive generally have more severe RA. The HLA type of 132 individuals with RA was examined. The HLA type HLA-DR4 was present in 31 out of 55 (56 percent) individuals who were positive for both RF and APF, 29 out of 39 (74 percent) individuals who were positive for RF but negative for APF, 10 out of 14 (71 percent) individuals who were RF-negative but positive for APF, and 9 out of 24 (37 percent) individuals who were negative for both RF and APF. The prevalence of HLA-DR4 was similar in groups positive for both factors and positive for at least one of the two factors, and lower in individuals who were negative for both factors. The overall prevalence of HLA-DR4 in patients with RA was greater than in the general population; prevalence among healthy controls was 55 out of 277, or 20 percent. The study concluded that HLA-DR4 is more prevalent in patients who are seronegative for RF and contain APF, compared with RF-seronegative patients who do not have the APF. This immunogenetic finding may be important in understanding differences among the various subgroups of RA. (Consumer Summary produced by Reliance Medical Information, Inc.)

Autoantibodies, HLA histocompatibility antigens, Rheumatoid factor, Immunogenetics, Antinuclear antibodies

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Genes associated with rheumatoid arthritis and mild inflammatory arthritis: 2. association of HLA with complement C3 and immunoglobulin Gm allotypes

Article Abstract:

Rheumatoid arthritis (RA) is a joint disease characterized by inflammation of the joints, stiffness, swelling, overgrowth of cartilage tissue, and pain. This joint disorder has been associated with increased levels of certain types of histocompatibility antigens (HLA), which are molecules present on all cells with a nucleus and whose expression is controlled by the major histocompatibility gene complex (MHC). RA has also been associated with altered levels of immunoglobulins (Ig; immune proteins), and complement (proteins that destroy bacteria and other foreign cells). The relationship between MHC genes located on chromosome 6 and the genes that control Ig and the complement protein C3 was assessed in patients with RA and mild inflammatory arthritis. The genes controlling C3 were increased in patients with inflammatory arthritis but were normal in RA patients and normal subjects. Patients with C3 genes had increased levels of certain MHC antigens, namely HLA-B8, DR3, and DR2, but decreased levels of other types of MHC antigens, such as DR4. The results suggest that C3 genes may influence the activity of certain MHC genes, thereby resulting in either increased susceptibility to or protection against disease. Genes that control the heavy chain portion of the Ig molecule were increased in certain RA patients with a specific genetic make-up. Relations between MHC, C3, and Ig genes differed between patients with RA and those with inflammatory arthritis, suggesting that these two joint disorders vary in their genetic features. (Consumer Summary produced by Reliance Medical Information, Inc.)

Identification and classification, Arthritis, Major histocompatibility complex, Complement (Immunology), Histocompatibility antigens

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Azathioprine induced fever, chills, rash, and hepatotoxicity in rheumatoid arthritis

Article Abstract:

Adverse reactions to the drug azathioprine are rare; this drug is given to patients who have rheumatoid arthritis (RA). Symptoms of hypersensitivity reactions to azathioprine include fever, pain in the muscles and joints, and rash. In a one-year period, three out of 25 patients treated with azathioprine for rheumatoid arthritis (RA) developed serious allergic reactions to the drug within two weeks of beginning treatment. Their symptoms included high fever and chills, rash, nausea, diarrhea, and elevated liver enzymes, which is a sign of liver damage. The combination of hypersensitivity reaction and liver toxicity, which occurred in two of the three patients, is very rare. Despite their reactions the first time, two of the three patients were given azathioprine again; they developed more severe symptoms with a more rapid onset, confirming hypersensitivity to the drug. Damage to the liver was not permanent, but in one case high levels of liver enzymes indicating liver toxicity still persisted seven months after the drug had been discontinued. The cause of the liver damage is not known but may result from: a systemic allergic reaction that occurs throughout the whole body, damage to the liver cells themselves, or blockage of the flow of blood in the liver. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Drug therapy, Liver, Azathioprine

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