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: J Rheumatol 1998 Sep;25(9):1687-1693 |
Comment in:
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J Rheumatol. 1999 Jul;26(7):1636
The development of rheumatoid arthritis after
recombinant hepatitis B vaccination.
Pope JE, Stevens A, Howson W, Bell DA.
Department of Medicine, the University of Western Ontario, London, Canada.
OBJECTIVE: Hepatitis B vaccination has been associated with reactive arthritis
and rarely rheumatoid arthritis (RA). We defined the clinical, serologic, and
immunogenetic background of patients developing RA, soon after recombinant
hepatitis B vaccination. METHODS: The clinical, serologic, and HLA antigens of
a cluster of firefighters who developed arthritis after prophylactic
recombinant hepatitis B vaccination (5 subjects), as well as a second group of
sporadic cases of arthritis (6 patients) after hepatitis B vaccination are
described. RESULTS: Ten of 11 patients fulfilled revised American College of
Rheumatology criteria for RA. All cases had persistent arthritis for more than
6 months; at 48 months followup 2 cases no longer had inflammatory arthritis.
Nine patients required disease modifying antirheumatic drugs. Five subjects
were HLA-DR4 positive. HLA class II genes expressing the RA shared motif were
identified in 9/11 patients genotyped for HLA-DRbeta1 and DQbeta1 alleles
(0401, 0101, or 0404). All the firefighters shared the HLA-DRbeta1 allele 0301
and the DQbeta1 allele 0201, with which it is in linkage disequilibrium.
CONCLUSION: These polymorphic residues in the binding site of the MHC class II
molecules of the affected patients appear capable of binding some peptide
sequences of the recombinant vaccine peptides they received and may be
responsible for hepatitis B vaccine triggering development of RA in these
cases. Recombinant hepatitis B vaccine may trigger the development of RA in MHC
class II genetically susceptible individuals.
PMID: 9733447 [PubMed - indexed for MEDLINE]
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