Khai Pang Leong1,3, Mei Yun Yong1, Liuh Ling Goh2, Chia Mun Woo1, Chia Wei Lim3, Ee Tzun Koh1

1Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
2Molecular Diagnostic Laboratory, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
3Personalized Medicine Service, Tan Tock Seng Hospital, Tan Tock Seng, Singapore

Keywords: Genetics, rheumatoid arthritis, sequencing


Objectives: This study aims to uncover variants of large effect size and allele frequency below 5% by sequencing all extant genes associated with rheumatoid arthritis (RA) in a homogeneous patient cohort.

Patients and methods: This retrospective study was conducted between January 2001 and December 2017. We selected Chinese RA patients positive for anti-citrullinated peptide antibody (ACPA). All the 128 known candidate genes identified through genome-wide association studies were sequenced in 48 RA patients (15 males, 33 females; mean age 53.32±8.98 years; range, 32 to 75 years) and 45 controls (11 males, 34 females; mean age 32.18±9.54; range, 21 to 57 years). The exonic regions of these genes were sequenced. The resultant data were analyzed for association using single variant association and pathway-based association enrichment tests. The genetic burden due to low-frequency variants was assessed with the C-alpha test. The candidate variants that showed significant association were validated in a larger cohort of 500 RA cases (71 males, 429 females; mean age 48.6±12.2 years; range, 24 to 92 years) and 500 controls (66 males, 434 females; mean age 32.3±10.1 years; range, 21 to 73 years).

Results: Thirty-nine variants in 21 genes were identified using single variant association analysis and C-alpha test, with stepwise filtering. Among these, the missense variant in interleukin-6 signal transducer (IL-6ST) 5:55260065 (p.Cys47Phe) was significantly associated with RA in Chinese patients in Singapore.

Conclusion: Our results suggest that a mutation in IL-6ST (5:55260065) confers risk of RA in Chinese patients in Singapore.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

This work is supported by the research grants from the National Healthcare Group Small Innovative Grant (SIG/15036) and Singapore National Medical Research Council (NMRC/CG/017/2013).


We thank Ms Jocelyn Gay and Ms Joo Yong Ong for data collection.