AbstractObjectivesTo assess the differences in circulating DNA methylation levels of CXCR5 between rheumatoid arthritis (RA) and osteoarthritis (OA) and healthy controls (HC), and the correlation of methylation changes with clinical characteristics of RA patients.MethodsPeripheral blood samples were collected from 239 RA patients, 30 patients with OA, and 29 HC. Target region methylation sequencing to the promoter region of CXCR5 was achieved using MethylTarget. The methylation level of cg04537602 and methylation haplotype were compared among the three groups, and the correlation between methylation levels and clinical characteristics of RA patients was performed by Spearman's rank correlation analysis.ResultsThe methylation level of cg04537602 was significantly higher in the peripheral blood of RA patients compared with OA patients (p= 1.3 × 10−3) and in the HC group (p= 5.5 × 10−4). The sensitivity was enhanced when CXCR5 methylation level combined with rheumatoid factor and anti–cyclic citrullinated peptide with area under curve (AUC) of 0.982 (95% confidence interval 0.970–0.995). The methylation level of cg04537602 in RA was positively correlated with C‐reactive protein (CRP) (r= .16,p= .01), and in RA patients aged 60 years and above, cg04537602 methylation levels were positively correlated with CRP (r= .31,p= 4.7 × 10−4), tender joint count (r= .21,p= .02), visual analog scales score (r= .21,p= .02), Disease Activity Score in 28 joints (DAS28) using the CRP level DAS28‐CRP (r = .27,p= 2.1 × 10−3), and DAS28‐ESR (r= .22,p= .01). We also observed significant differences of DNA methylation haplotypes in RA patients compared with OA patients and HC, which was consistent with single‐loci‐based CpG methylation measurement.ConclusionThe methylation level of CXCR5 was significantly higher in RA patients than in OA and HC, and correlated with the level of inflammation in RA patients, our study establishes a link between CXCR5 DNA methylation and clinical features that may help in the diagnosis and disease management of RA patients.