In general, most studies agree on a worse prognosis of RA in women, although there is a subgroup of men with a highly disabling disease. The presence of HLA-DR4 and / or rheumatoid epitope ( Keto Viante) has been associated with greater structural damage in patients with RA, especially in Anglo-Saxon countries.
The homozygosity for the epitope, especially in the alleles DR0401 and DR404, is associated with a greater severity of the disease, both joint and extra-articular. The presence of the epitope outside a DR4 molecule (like DR1) seems to imply a somewhat better prognosis.
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