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Peru H, Soylemezoglu O, Gonen S, Cetinyurek A, Bakkaloğlu SA, Buyan N, Hasanoglu E. HLA class 1 associations in Henoch Schonlein purpura: increased and decreased frequencies. Clin Rheumatol 2007; 27:5-10. [PMID: 17487448 DOI: 10.1007/s10067-007-0640-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2007] [Revised: 04/16/2007] [Accepted: 04/17/2007] [Indexed: 11/25/2022]
Abstract
Henoch Schonlein purpura (HSP) is the most common vasculitis of childhood. Susceptibility to HSP and associated clinical heterogeneity in HSP may be conferred by a number of genetic loci, including the major histocompatibility complex. We aimed to investigate the implications of the human leukocyte antigen (HLA) class 1 alleles in susceptibility to HSP and determine the possible associations with renal, gastrointestinal (GI), and joint manifestations of the disease. 110 children with HSP (66 boys, 44 girls) and 250 unrelated healthy controls were enrolled in the study. The mean age was 8.65 +/- 3.59 years. HSP was diagnosed on the basis of clinical and laboratory data according to the American College of Rheumatology classification. The diagnosis was supported with skin and/or kidney in most of the patients. Clinical and laboratory findings revealed: skin involvement in 110 (100%), joint manifestations in 82 (74.5%), GI symptoms in 58 (52.7%), and hematuria and/or proteinuria in 36 (32.7%) patients. HLA class 1 alleles were identified by DNA amplification, hybridized with specific primer sequences. Comparison of frequencies between patients and controls were made by using the Fisher's exact test. Odds ratio (OR) was used as the measure of association. HLA A2, A11, and B35 antigens showed an increased risk for predisposition to HSP (OR = 1.714, 95%CI = 1.088-2.700, p = 0.020; OR = 2.185, 95%CI = 1.289-3.703, p = 0.003; and OR = 2.292, 95%CI = 1.451-3.619, p = 0.000, respectively), while HLA A1, B49, and B50 antigens revealed decreased risk for predisposition to HSP (OR = 4.739, 95%CI = 1.828-12.345, p = 0.001; OR = 3.268, 95%CI = 0.955-11.236, p = 0.047; and OR = 7.462, 95%CI = 0.975-55.555, p = 0.024, respectively). Considering the renal involvement and severity of proteinuria, there was no association with HLA class 1 alleles. Our results suggest that the increased frequency of HLA A2, A11, and B35 alleles in unselected pediatric HSP patient population and miscarrying of HLA A1, B49, and B50 could be considered as a risk factor for susceptibility to HSP.
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Affiliation(s)
- Harun Peru
- Department of Pediatric Nephrology, Gazi University Hospital, Besevler, Ankara, Turkey, 06540.
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Nowack R, Lehmann H, Flores-Suárez LF, Nanhou A, van der Woude FJ. Familial occurrence of systemic vasculitis and rapidly progressive glomerulonephritis. Am J Kidney Dis 1999; 34:364-73. [PMID: 10430990 DOI: 10.1016/s0272-6386(99)70371-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Two familial clusters of systemic vasculitis are described. In one family, microscopic polyangiitis and rapidly progressive glomerulonephritis occurred in HLA-identical siblings; in the second family, 3 second- and fourth-degree related members were affected by Wegener's granulomatosis. Published clusters of systemic vasculitides and Goodpasture's syndrome are reviewed, and, together with the observed families, the evidence for genetic susceptibility and a causative role of environmental factors for these diseases with special emphasis on the HLA system is discussed.
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Affiliation(s)
- R Nowack
- V(th) Medical Clinic (Nephrology, Endocrinology), University-Clinic Mannheim, Zweibrücken, Germany.
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Schneider HA, Yonker RA, Katz P, Longley S, Panush RS. Rheumatoid vasculitis: experience with 13 patients and review of the literature. Semin Arthritis Rheum 1985; 14:280-6. [PMID: 3909408 DOI: 10.1016/0049-0172(85)90047-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Rheumatoid vasculitis is an uncommon but potentially catastrophic complication of RA. There are few current extensive experiences and no consensus regarding the clinical, laboratory, histologic features, and management or prognosis of rheumatoid vasculitis. We therefore reviewed selected observations in 13 patients followed over the past decade and compared them with patients reported and with results of a survey of North American Rheumatologists. Our patients were seven men and six women (age, 33 to 70 years) who had had active RA for 4 to 36 years. They exhibited sensory neuropathy, mononeuritis multiplex, Felty syndrome, cutaneous lesions, leg ulcers, gangrene, anemia, leukocytosis, eosinophilia, high titers of RF, hypocomplementemia, and CICs or cryoglobulinemia approximately as frequently as other reported patients with rheumatoid vasculitis, but they displayed constitutional symptoms, subcutaneous nodules, ischemic changes, and proteinuria rather less consistently than in other series. These observations were not necessarily as expected by survey respondents. We, as in other series and suggested by survey respondents, tended to select penicillamine or cytotoxic drugs (or plasmapheresis) for patients with mononeuritis, gangrene, or leg ulcers, and nonsteroidal antiinflammatory drugs, antimalarials, gold, or penicillamine for sensory neuropathy or digital lesions. Four patients died, two deteriorated, and seven were stable or improved, a finding that was also similar to the experiences of others. Rheumatoid vasculitis is an uncommon, potentially catastrophic syndrome with varying clinico-pathologic features that have different prognostic implications and should be managed individually.
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Panush RS, Katz P, Longley S, Love J, Stanley H. Rheumatoid vasculitis: diagnostic and therapeutic decisions. Clin Rheumatol 1983; 2:321-30. [PMID: 6678193 DOI: 10.1007/bf02041550] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Rheumatoid vasculitis is an uncommon but potentially catastrophic complication of RA. There are few extensive experiences recorded in the current literature and there is no consensus regarding the clinical features, laboratory findings, histologic pattern, prognosis, or appropriate management of this syndrome. We therefore surveyed 1,947 North American ARA members for their perceptions of rheumatoid vasculitis. Four hundred twenty-eight surveys were returned, of which 290 were suitable for analysis. The majority of respondents were within 10 years of fellowships and were evenly distributed among private practice, and part-time and full-time academic positions. The respondents saw 15-50 rheumatoid arthritis (RA) patients weekly and less than five RA vasculitis patients annually. The majority correctly diagnosed two actual and complex case histories from patients with and without autopsy-proven vasculitis. Respondents associated the following features most strongly with rheumatoid vasculitis - mononeuritis multiplex, digital gangrene, digital ischemic lesions, nailfold ischemic lesions, non-healing leg ulcers, palpable purpura, fingertip nodules, sensory neuropathy, scleromalacia perforans, high titer rheumatoid factor, positive visceral angiography, cryoglobulinemia, hypocomplementemia, circulating immune complexes, and histologic necrotizing vasculitis or vascular transmural neutrophilia. Digital lesions or sensory neuropathy alone were not viewed as portending an ominous prognosis by most respondents and would have been treated with nonsteroidal anti-inflammatory drugs, antimalarials, gold salts, or D-penicillamine. Other clinical manifestations considered as reflecting rheumatoid vasculitis (gangrene, mononeuritis multiplex, ulcers) were thought to worsen prognosis and would have been managed more often with corticosteroids, D-penicillamine, cytotoxic agents or plasmapheresis. Rheumatoid vasculitis is viewed as a heterogeneous group of syndromes with varying clinical and histopathologic features,which have different prognostic implications, and therefore should be managed differently. While these dta do not substitute for an extensive recorded series of patients, they provide useful information about community perceptions of an uncommon but difficult clinical problem. They identify the need for additional data to examine the validity of these attitudes.
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Abstract
Rheumatoid arthritis is a systemic disease which can have multiple cutaneous manifestations. In particular, rheumatoid vasculitis may be difficult to diagnose because of the wide array of clinical presentations. Early recognition can assist the physician in diagnosis and in determination of the proper therapy. Every physician caring for patients with rheumatoid arthritis should be aware of these common dermatologic complications.
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Cunningham TJ, Tait BD, Mathews JD, Muirden KD. Clinical rheumatoid vasculitis associated with the B8 DR3 phenotype. Rheumatol Int 1982; 2:137-9. [PMID: 6984537 DOI: 10.1007/bf00541167] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A statistically significant association of clinical rheumatoid vasculitis (excluding nodules or nail-fold infarcts only) with the HLA B8 DR3 phenotype was found when comparing 30 patients with vasculitis with 84 classic or definite rheumatoid patients without clinical vasculitis. The previously reported association on HLA DR4 with rheumatoid disease was also confirmed.
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Fraser PA, Schur PH. Hypoimmunoglobulinemia D: frequency, family studies, and association with HLA. CLINICAL IMMUNOLOGY AND IMMUNOPATHOLOGY 1981; 19:67-74. [PMID: 7214744 DOI: 10.1016/0090-1229(81)90048-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Glass DN, Litvin DA. Heterogeneity of HLA associations in systemic onset juvenile rheumatoid arthritis. ARTHRITIS AND RHEUMATISM 1980; 23:796-9. [PMID: 7406930 DOI: 10.1002/art.1780230704] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Two genetic markers, HLA-Bw35 and HLA-B8, are found to be associated with "febrile" or "systemic" onset juvenile rheumatoid arthritis (JRA). Evidence is presented that JRA patients are probably heterogeneous with respect to these antigens.
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Kammer GM, Soter NA, Schur PH. Circulating immune complexes in patients with necrotizing vasculitis. CLINICAL IMMUNOLOGY AND IMMUNOPATHOLOGY 1980; 15:658-72. [PMID: 7357763 DOI: 10.1016/0090-1229(80)90011-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Rossen RD, Brewer EJ, Sharp RM, Ott J, Templeton JW. Familial rheumatoid arthritis: linkage of HLA to disease susceptibility locus in four families where proband presented with juvenile rheumatoid arthritis. J Clin Invest 1980; 65:629-42. [PMID: 6766468 PMCID: PMC371404 DOI: 10.1172/jci109708] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The occurrence of a chronic seronegative polyarthritis has been studied in four families in which the proband presented with some form of juvenile rheumatoid arthritis. In these families, histocompatibility testing suggested that susceptibility to arthritis was controlled by a dominant allele with variable penetrance and expressivity at the rheumatoid-like arthritis, first locus (RLA-1). The combined lod scores for the four families (2.70) indicated that the odds in favor of genetic linkage between the major histocompatibility complex and the postulated disease susceptibility gene, RLA-1, were 500:1. In one family, a recombinant event permitted localization of RLA-1 centromeric to HLA-D. Of major interest was the fact that there was significant pleomorphism in the clinical manifestations of arthritis in affected individuals. In some, symptoms first occurred in childhood and in others, in adult life. Even among those with childhood-onset arthritis, different types of juvenile rheumatoid arthritis were observed within the same family.
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Kammer GM, Soter NA, Gibson DJ, Schur PH. Psoriatic arthritis: a clinical, immunologic and HLA study of 100 patients. Semin Arthritis Rheum 1979; 9:75-97. [PMID: 392764 DOI: 10.1016/s0049-0172(79)80001-3] [Citation(s) in RCA: 152] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Cleland LG, Bell DA, Willans M, Saurino BC. Familial lupus. Family studies of HLA and serologic findings. ARTHRITIS AND RHEUMATISM 1978; 21:183-91. [PMID: 305780 DOI: 10.1002/art.1780210202] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
HLA profiles in 103 members of 4 separate kindred with multiple occurrence of SLE were compatible with the presence of a disease susceptibility factor linked to HLA or a direct effect of antigens B8, A11, and B35 on disease expression. Serum ANA was found in 52.9% of consanguineous, 56.5% of nonconsanguineous relatives of SLE probands, and 5% of controls, a finding that suggests the presence of a transmissible agent in the families. By contrast, lymphocytotoxic antibodies were not increased in relatives compared to controls.
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Raum D, Glass D, Soter NA, Stillman JS, Carpenter CB, Schur PH. Lymphocytotoxic antibodies. HLA antigen associations, disease associations, and family studies. ARTHRITIS AND RHEUMATISM 1977; 20:933-6. [PMID: 16618 DOI: 10.1002/art.1780200405] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Lymphocytotoxic antibodies (LCTAB) were sought in sera of patients with rheumatic diseases and in family members. Patients with SLE and cutaneous necrotizing venulitis and family members of JRA patients had an increased frequency of LCTAB; JRA patients and family members of SLE patients did not. The only association between LCTAB and the HLA phenotype of persons with LCTAB was a decreased frequency of LCTAB in individuals with HLA-B27.
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