ABSTRACT

Objective:

Ankylosing spondylitis (AS) is a chronic, inflammatory disease affecting the spine and sacroiliac joints. The relation between HLA B-27 and AS is one of the most interesting models for the association between a molecule and human disease. Our aim in this study was to evaluate the clinical, laboratory and radiologic findings and treatment of HLA B-27 negative AS patients and to compare with HLA B-27 positive AS patients.

Methods:

In this study, medical files of 451 patients who were classified as AS according to 1984 Modified New York and 2009 ASAS (Assessment of SpondyloArthritis International Society) classification criteria were retrospectively evaluated. The demographic features, clinical and laboratory findings and treatments of the HLA B-27 positive and nepative AS patients were recorded and compared with apropriate statistical tests.

Results:

Of the 451 AS patients, 340 (75.4%) were HLA B-27 positive. Gender, age, age at the beginning of symptoms, age at diagnosis, delay in diagnosis, frequency of radyographic sacroiliitis and treatment choices did not show any difference among groups (p>0.05, for all). Uveitis was more common in HLA B-27 positive AS patients (p=0.010) whereas inflammatory bowel disease was more common in HLA B-27 negative AS patients (p=0.002).

Conclusion:

In this study, HLA B-27 was not decisive for the features of AS. It is known that there are roles of other genetic polymorphisms in the pathogenesis of AS. Some of the differences may result from these genetic differences.

References

1Gran J, Teisberg P, Olaissen B, Thorsby E, Husby G. HLA-B27 and allotypes of complement components in ankylosing spondylitis. J Rheumatol 1984;11:324-6.

2Gunal EK, Sarvan FO, Kamali S, et al. Low frequency of HLA-B27 in ankylosing spondylitis patients from Turkey. Joint Bone Spine 2008;75:299-302.

3Garcia-Montoya L, Gul H, Emery P. Recent advances in ankylosing spondylitis: understanding the disease and management. F1000Res 2018;7:F1000 Faculty Rev-1512. doi: 10.12688/f1000research.14956.1

4Akkoç N, Yarkan H, Kenar G, Khan MA. Ankylosing spondylitis: HLA-B* 27-positive versus HLA-B* 27-negative disease. Curr Rheumatol Rep 2017;19:26.

5van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984;27:361-8.

6Rudwaleit M, van der Heijde D, Landewé R, et al The development of Assessment of Spondyloarthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009;68:777-83.

7Omar D, Qian M, Almansoub HA, Dong L. The role of HLA B27 in the treatment response, functional limitation and disease activity in ankylosing spondylitis patients. Euro J Biomed Pharma Sci 2019;6:537-44.

8Arévalo M, Masmitjà JG, Moreno M, et al. Influence of HLA-B27 on the Ankylosing Spondylitis phenotype: results from the REGISPONSER database. Arthritis Res Ther 2018;20:221.

9Chen B, Li J, He C, et al. Role of HLA-B27 in the pathogenesis of ankylosing spondylitis. Mol Med Rep 2017;15:1943-51.

10Mekhola MH, Chowdhury MAJ, Ahmed MS, Khan AH, Paul S. Frequency of HLA-B27 gene among patients with ankylosing spondylitis and its consequences on clinical manifestation. Bridem Med J 2019;9:188-92.

11Zhang S, Wang Y, Peng L, et al. Comparison of clinical features in HLA-B27 Positive and negative patients with axial spondyloarthritis: results from a cohort of 4,131 patients. Front Med (Lausanne) 2020:23;7:609562.

12Yang M, Xu M, Pan X, et al. Epidemiological comparison of clinical manifestations according to HLA-B* 27 carrier status of Chinese Ankylosing Spondylitis patients. Tissue Antigens 2013;82:338-43.

13Jung Y-O, Kim I, Kim S, et al. Clinical and radiographic features of adult-onset ankylosing spondylitis in Korean patients: comparisons between males and females. J Korean Med Sci 2010;25:532-5.

14Feldtkeller E, Khan M, van der Heijde D, van der Linden S, Braun J. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheum Int 2003;23:61-6.

15Wu Z, Lin Z, Wei Q, Gu J. Clinical features of ankylosing spondylitis may correlate with HLA-B27 polymorphism. Rheum Int 2009;29:389-92.

16Fırat SN, Yazıcı A, Yılmazer B, Coşan F, Savlı H, Cefle A. Low frequency of HLA-B27 in ankylosing spondylitis and its relationship with clinical findings in patients from Turkey. Eur J Rheumatol 2017;4:268.

17Chung HY, Machado P, Van Der Heijde D, d’Agostino M-A, Dougados M. HLA-B27 positive patients differ from HLA-B27 negative patients in clinical presentation and imaging: results from the DESIR cohort of patients with recent onset axial spondyloarthritis. Ann Rheum Dis 2011;70:1930-6.

18Jung J, Bang CH, Seok H, Choi SJ, Song GG. Clinical findings of Ankylosing Spondylitis with and without Human Leukocyte Antigen (HLA)-B27 and HLA-B51. Ann Acad Med Singap 2019;48:321-9.

19Abdulhadi MM, Al-Musawi BM, Al-Osami MH. Molecular and serologic Detection of HLA-B27 among ankylosing spondylitis patients with some clinical correlations. Iraqı Postgred Med J 2018;17:261-70.

20Lin H, Gong Y-Z. Association of HLA-B27 with ankylosing spondylitis and clinical features of the HLA-B27-associated ankylosing spondylitis: a meta-analysis. Rheumatol Int 2017;37:1267-80.

21Gouveia EB, Elmann D, Morales MS. Ankylosing spondylitis and uveitis: overview. Rev Bras Rheumatol 2012;52:749-56.

22Chang JH, McCluskey PJ, Wakefield D. Acute anterior uveitis and HLA-B27. Surv Opthalmol 2005;50:364-88.

23Wakefield D, Chang JH, Amjadi S, et al. What is new HLA-B27 acute anterior uveitis? Ocul Immunol Inflamm 2011;19:139-44.

24Yazici A, Ozdemir Isik O, Temiz Karadag D, Cefle A. Are there any clinical differences between ankylosing spondylitis patients and familial Mediterranean fever patients with ankylosing spondylitis? Int J Clin Pract 2021;75:e13645.

25Linssen A. B27+ disease versus B27- disease. Scand J Rheumatol Suppl 1990;87:111-8; discussion 118-9.

26van Lunteren M, Sepriano A, Landewé R, et al. Do ethnicity, degree of family relationship, and the spondyloarthritis subtype in affected relatives influence the association between a positive family history for spondyloarthritis and HLA-B27 carriership? Results from the worldwide ASAS cohort. Arthritis Res Ther 2018;20:166.

Are HLA B-27 negative and positive ankylosing spondylitis patients different?

ABSTRACT

References