DNA typing of HLA-DR antigens in systemic lupus erythematosus.

HLA-DR typing is technically difficult in systemic lupus erythematosus (SLE), where patients have low numbers of peripheral B cells, often of poor viability and weak in antigenic expression. In this series, one third of SLE patients could not be HLA-DR typed by serological techniques, highlighting the potential for systematic bias in DR antigen assignment in studies of HLA and SLE. This potential bias was examined by comparing serological DR results with DNA-DR typing, achieved by examining Taq I fragments of DR beta, DQ alpha, and DQ beta which permitted unequivocal DR phenotyping of all patients, including the 35% for whom conventional DR typing was technically impossible. This showed the success of serological DR antigen assignment was indeed nonrandom, with HLA-DR2 and -DR3 significantly more readily identifiable than DR5 and DRw13. Our study suggests that technical problems may well have contributed to conflicting reports regarding the association of DR2 or DR3 with SLE. Here, DNA-DR phenotyping showed HLA-DR3 is significantly (P less than .05) associated with an increased risk for SLE (54% in 46 patients, 36% in 134 controls) and HLA-DR2 is not.