HLA-B27 positivity and associated factors in spondyloartritis patients from Turkey: a single-center study

Year 2025, Volume: 7 Issue: 2, 223 - 229, 21.03.2025

Zehra Özsoy , Yelda Öztürk , Zeynep Öztürk , Esin Beyan

https://doi.org/10.38053/acmj.1647658

Abstract

Aims: Spondyloarthropathies (SpA) constitute a category of multisystemic inflammatory seronegative arthritis. A genetic correlation exists between SpA and the human leukocyte antigen (HLA)-B27 gene. HLA-B27 positive is observed in roughly 90% of patients with ankylosing spondylitis. This study seeks to ascertain the prevalence of HLA-B27 positivity and its associated factors in SpA patients within the Turkish population, while also comparing the demographic, clinical, and radiological characteristics between HLA-B27 positive and negative groups, their utilization of bDMARDs, and the baseline and post treatment disease activity metrics.
Methods: The study comprised 300 patients having accessible HLA-B27 findings. SpA patients were classified into two groups according to their HLA-B27 status: positive and negative. Demographic parameters, HLA-B27 results, disease activity scores, and the existence of radiographic abnormalities were documented in both groups.
Results: Of the 300 patients involved in the study, 224 (74.7%) tested positive for HLA-B27. The median age of all patients was 45 years, with HLA-B27 positive individuals being younger. The median age for symptom start was 35 years, while the median age for diagnosis was 39 years. Analysis of the radiographic features based on ASAS criteria indicated that the radiographic axial SpA group comprised the largest proportion of patients at 69.2%, followed by non-radiographic axial SpA at 23.4%, and peripheral SpA at 7.4%. Upon comparison of the two groups, the seropositive cohort exhibited a markedly elevated prevalence of familial history. Hypertension was the predominant comorbidity in both the HLA-B27 positive and negative cohorts. The prevalence of smokers was markedly greater in the HLA-B27 positive cohort. The frequencies of radiographic sacroiliitis, syndesmophytes, bamboo spine, and hip involvement were elevated in the positive group when compared. Uveitis exhibited greater prevalence in the positive cohort. Upon comparison of the two groups, the post-treatment reductions in BASDAI, BASFI, VAS Pain, ESR, and CRP levels were more pronounced in the positive group than in the negative group. In comparing the HLA-B27 positive and negative cohorts, no significant disparities were observed in the frequency of single or multiple treatment modifications. Nevertheless, the alteration of bDMARD treatment was less common in the HLA-B27 positive cohort than in the negative cohort.
Conclusion: HLA-B27-positive patients were younger, mostly male, experienced an earlier onset of disease, and demonstrated a more active disease progression. The treatment response was superior in the positive group relative to the negative group.

Keywords

HLA-B27, spondyloarthropathies, seropositive, seronegative

Ethical Statement

Our study was in accordance with the 2013 amendment of the Helsinki declaration and ethical approval was obtained from Health Sciences University Ankara Atatürk Sanatorium Training and Research Hospital Institutional Review Board (2024-BÇEK/180, 11/12/2024).

Supporting Institution

none

Thanks

none

References

• Öntürk ÖA, Bilge ŞY, Bilgin M, Kaşifoğlu T. Are HLA B-27 negative and positive ankylosing spondylitis patients different? J Turkish Society Rheumatol. 2021;13(2):54-58. doi:10.4274/raed.galenos.2021.49469
• Gran J, Teisberg P, Olaissen B, Thorsby E, Husby G. HLA-B27 and allotypes of complement components in ankylosing spondylitis. J Rheumatol. 1984;11(3):324-326.
• Braun J, Bollow M, Remlinger G, et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum. 1998;41(1):58-67. doi:10.1002/1529-0131(199801)41:1<58::AID-ART8>3. 0.CO;2-G
• Gunal EK, Sarvan FO, Kamali S, et al. Low frequency of HLA-B27 in ankylosing spondylitis patients from Turkey. Joint Bone Spine. 2008; 75(3):299-302. doi:10.1016/j.jbspin.2007.06.021
• Garcia-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
• Akkoç N, Yarkan H, Kenar G, Khan MA. Ankylosing spondylitis: HLA-B* 27-positive versus HLA-B* 27-negative disease. Curr Rheumatol Rep. 2017;19(5):26. doi:10.1007/s11926-017-0654-8
• Caffrey MF, James DC. Human lymphocyte antigen association in ankylosing spondylitis. Nature. 1973;242(5393):121. doi:10.1038/ 242121a0
• Schlosstein L, Terasaki PI, Bluestone R, Pearson CM. High association of an HL-A antigen, W27, with ankylosing spondylitis. N Engl J Med. 1973;288(14):704-706. doi:10.1056/NEJM197304052881403
• Kim TJ, Na KS, Lee HJ, Lee B, Kim TH. HLA-B27 homozygosity has no influence on clinical manifestations and functional disability in ankylosing spondylitis. Clin Exp Rheumatol. 2009;27(4):574-579.
• Alamanos Y, Papadopoulos NG, Voulgari PV, Karakatsanis A, Siozos C, Drosos AA. Epidemiology of ankylosing spondylitis in Northwest Greece, 1983-2002. Rheumatology (Oxford). 2004;43(5):615-618. doi:10. 1093/rheumatology/keh133
• Feldtkeller E, Khan MA, 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. Rheumatol Int. 2003;23(2):61-66. doi:10.1007/s00296-002-0237-4
• Yang M, Xu M, Pan X et al. Epidemiological comparison of clinical manifestations according to HLA-B27 carrier status of Chinese ankylosing spondylitis patients. Tissue Antigens. 2013;82(5):338-343. doi:10.1111/tan.12186
• Chung HY, Machado P, van der Heijde D, D’Agostino MA, 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(11):1930-1936. doi:10.1136/ard.2011.152975
• Sampaio-Barros PD, Bertolo MB, Kraemer MH, Neto JF, Samara AM. Primary ankylosing spondylitis: patterns of disease in a Brazilian pop- ulation of 147 patients. J Rheumatol. 2001;28(3):560-565.
• Kim TJ, Kim TH. Clinical spectrum of ankylosing spondylitis in Korea. Joint Bone Spine. 2010;77(3):235-240. doi:10.1016/j.jbspin. 2009.11.015
• Khan MA, Kushner I, Braun WE. Comparison of clinical features in HLA-B27 positive and negative patients with ankylosing spondylitis. Arthritis Rheum. 1977;20(4):909-912.
• Jaakkola E, Herzberg I, Laiho K et al. Finnish HLA studies confirm the increased risk conferred by HLA-B27 homozygosity in ankylosing spondylitis. Ann Rheum Dis. 2006;65(6):775-780. doi:10.1136/ard.2005. 041103
• Amor B, Santos RS, Nahal R, Listrat V, Dougados M. Predictive factors for the longterm outcome of spondyloarthropathies. J Rheumatol. 1994; 21(10):1883-1887.
• Jung 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(10):321-329.
• Abdulhadi 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(3):261-270.
• Chang JH, McCluskey PJ, Wakefield D. Acute anterior uveitis and HLA-B27. Surv Opthalmol. 2005;50(4):364-388. doi:10.1016/j.survophthal.2005.04.003
• Wakefield D, Chang JH, Amjadi S, et al. What is new HLA-B27 acute anterior uveitis? Ocul Immunol Inflamm. 2011;19(2):139-144. doi:10.3109/09273948.2010.542269
• Machado P, Landewe R, Braun J, et al. Ankylosing spondylitis patients with and without psoriasis do not differ in disease phenotype. Ann Rheum Dis. 2013;72(6):1104-1107. doi:10.1136/annrheumdis-2012-202922
• Palm O, Moum B, Ongre A, Gran JT. Prevalence of ankylosing spondylitis and other spondyloarthropathies among patients with inflammatory bowel disease: a population study (the IBSEN study). J Rheumatol. 2002;29(3):511-515.
• Boonen A, vander Cruyssen B, de Vlam K, et al. Spinal radiographic changes in ankylosing spondylitis: association with clinical characteristics and functional outcome. J Rheumatol. 2009;36(6):1249-1255. doi:10.3899/jrheum.080831
• Ward MM, Hendrey MR, Malley JD, et al. Clinical and immunogenetic prognostic factors for radiographic severity in ankylosing spondylitis. Arthritis Rheum. 2009;61(7):859-866. doi:10.1002/art.24585
• Zhang 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. doi:10.3389/fmed.2020.609562
• van 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(1):166. doi:10.1186/s13075-018-1672-2
• Jaakkola E, Herzberg I, Laiho K, et al. Finnish HLA studies confirm the increased risk conferred by HLA-B27 homozygosity in ankylosing spondylitis. Ann Rheum Dis. 2006;65(6):775-780. doi:10.1136/ard.2005. 041103
• Omar 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;6:537-544.