Analysis of HLA-B15 and HLA-B27 in spondyloarthritis with peripheral and axial clinical patterns

Abstract

ObjectiveHuman leucocyte antigen (HLA) B27 and HLA-B15 are associated with spondyloarthritis (SpA). Recent Assessment of SpondyloArthritis international Society (ASAS) criteria emphasise a distinction between SpA with axial and peripheral patterns. We analysed whether HLA-A, HLA-B and HLA-DRB1 alleles could associate with these patterns.MethodsWe studied 100 healthy individuals and 178 patients with SpA according to European Spondyloarthropathy Study Group (ESSG) criteria. Patients were then classified according to ASAS criteria, the axial spondyloarthritis pattern (axSpA) being defined by ascertained sacroiliitis and the peripheral pattern (pSpA) by enthesitis and/or arthritis in extremities. A combined ax/p pattern was also considered.ResultsOnly HLA-B27 and HLA-B15 alleles were associated with SpA. ASAS criteria for axSpA were met in 152 patients (12 with isolated axSpA and 140 with a combined ax/p patterns). When the ASAS peripheral criteria were applied, 161 patients met these criteria (13 with isolated pSpA and 148 with a combined ax/p pattern). HLA-B27 was found in 83% of patients with axSpA and 43% of ax/pSpA patients according to axASAS. HLA-B27 occurred in 7% controls but not in any patient with isolated pSpA. HLA-B15 was encountered in 31% of patients with isolated pSpA and 20% of ax/pSpA patients according to pASAS criteria. Moreover, 2 healthy controls, but none of our patients with isolated axSpA were positive for HLA-B15.ConclusionsOur data suggest that the presence of HLA-B15 favours the development of isolated/combined peripheral rather than isolated axSpA, while HLA-B27 promotes an isolated/combined axial disease and excludes a peripheral pattern. HLA-B15 should be considered in addition to HLA-B27 when diagnosing patients with SpA according to ASAS criteria.

HLA class I and II alleles in susceptibility to ankylosing spondylitis

“…We could not confirm some other associations described in smaller AS or SpA cohorts elsewhere32–34 perhaps due to clinical heterogeneity. One small recent study of HLA-A, HLA-B, HLA-C and DRB1 alleles in 75 Moroccan patients with AS reported an allele frequency of HLA-B*27 of 32%, with associations also seen with B*57 , C*02 and DRB1*15 and negative associations with HLA-B*35 and B*49 32.…”

“…The reasons for the discrepancies of these data and ours are hard to interpret given the small size of the cohort, which precluded examination of HLA-B*27 negatives. Another recent study of 189 Colombian patients with SpA (including 87 with AS, but also reactive arthritis and undifferentiated SpA) found associations with HLA-B*15 as well as with HLA-DRB1*01 and HLA-DRB1*04 as well as with HLA-B*27 , which occurred at an allele frequency of 26.2% 34. Again, the small size of the cohort of patients with AS did not allow examination of HLA-B*27 negatives.…”

Chondrocyte activity is increased in psoriatic arthritis and axial spondyloarthritis

“…Joint structural elements and entheses of the axial and peripheral skeleton are principal targets of the diseases [ 1 ], which are occasionally also manifested at extraskeletal sites (e.g., anterior uveitis, aortic valvulopathy, and apical lung fibrosis) [ 1 , 2 ]. Both genetic and environmental factors are implicated in the disease course [ 3 – 5 ], and human leukocyte antigen (HLA)-B27 is overrepresented, occurring in up to 83 % of patients with axial involvement [ 6 ].…”

The treatment journey for patients with axial spondyloarthritis in North Africa and the Middle East: From diagnosis to management

“…○ HLA-B15 has been associated with combined peripheral and axSpA, as well as peripheral SpA, in studies from Colombia, Tunisia, Belgium, and Mexico. 40 (4) Accessibility • Health authorities should improve patients' access to novel medications.…”