Figure 6. Summary of results on the role of HLA-SE and smoking in the asymptomatic and symptomatic phase of rheumatoid arthritis development.
Meta-analyses in the asymptomatic stage indicated that smoking, but not HLA-SE, is involved in development of ACPA. At CSA onset, both HLA-SE and smoking were associated with presence of ACPA. Only HLA-SE further stimulated progression towards arthritis and ACPA-positive RA. Together these data imply that smoking is involved in autoantibody- and symptom-development, HLA-SE plays a role in autoantibody-maturation, symptom-development and progression to clinical disease.