Empirically derived subgroups in rheumatoid arthritis: association with single-nucleotide polymorphisms on chromosome 6

Rheumatoid arthritis (RA) is a disorder with important public health implications. It is possible that there are clinically distinctive subtypes of the disorder with different genetic etiologies. We used the data provided to the participants in the Genetic Analysis Workshop 15 to evaluate and describe clinically based subgroups and their genetic associations with single-nucleotide polymorphisms (SNPs) on chromosome 6, which harbors the HLA region. Detailed two- and three-SNP haplotype analyses were conducted in the HLA region. We used demographic, clinical self-report, and biomarker data from the entire sample (n = 8477) to identify and characterize the subgroups. We did not use the RA diagnosis itself in the identification of the subgroups. Nuclear families (715 families, 1998 individuals) were used to examine the genetic association with the HLA region. We found five distinct subgroups in the data. The first comprised unaffected family members. Cluster 2 was a mix of affected and unaffected in which patients endorsed symptoms not corroborated by physicians. Clusters 3 through 5 represented a severity continuum in RA. Cluster 5 was characterized by early onset severe disease. Cluster 2 showed no association on chromosome 6. Clusters 3 through 5 showed association with 17 SNPs on chromosome 6. In the HLA region, Cluster 3 showed single-, two-, and three-SNP association with the centromeric side of the region in an area of linkage disequilibrium. Cluster 5 showed both single- and two-SNP association with the telomeric side of the region in a second area of linkage disequilibrium. It will be important to replicate the subgroup structure and the association findings in an independent sample.