The Frequency of HLA-B27 Antigen Positivity in Patients with Rheumatoid Arthritis and Anklylosing Spondylitis and The Relationship Between HLA-B27 Antigen and Other Autoantibodies

Year 2024, Volume: 6 Issue: 2, 136 - 142, 30.06.2024

Gülseren Demir Karakılıç , Esra Şahingöz Bakırcı , Ferda Büyük

https://doi.org/10.52827/hititmedj.1401533

Abstract

Objective: The aim of this study was to research the frequency of Human Leukocyte Antigen (HLA)-B27 antigen positivity and relationship between HLA-B27 positivity and other autoantibodies and between HLA-B27 positivity and treatment in patients diagnosed with rheumatoid arthritis (RA) and ankylosing spondylitis (AS).
Material and Method: The study is a retrospective study. Patients diagnosed with RA and AS as a result of the examinations performed at Physical Medicine and Rehabilitation outpatient clinic between January 2017 and September 2022 were retrospectively screened, and patients whose HLA-B27 antigen was tested were included in study.
Results: A total of 569 patients, 199 with RA and 370 with AS were included in study. While HLA-B27 was positive in 11% of patients with RA, it was 37.5% in patients with AS and there was a significant difference between the groups. When we analyzed the correlation of autoantibodies with HLA-B27, we found that HLA-B27 was not correlated with RF, Anti-cyclic citrullinated peptides (Anti-CCP) or Anti-nuclear antibody (ANA). When we analyzed the relationship between HLA-B27 and the treatment method, there was no significant relationship between HLA-B27 and treatment method.
Conclusion: While HLA-B27 was found to be 5% positive in the general population in the literature, we found 11% in 199 patients with RA. This study is important because it shows that HLA-B27 positivity is not very common in patients diagnosed with AS recently contrary to popular belief. More studies are needed to evaluate HLA-B27 frequency in RA and AS.

Keywords

Ankylosing Spondylitis, correlation of autoantibodies, HLA-B27 antigen, Rheumatoid Arthritis

Ethical Statement

Before the study, the study protocol was approved by the Ankara City Hospital No. 2 Clinical Research Ethics Committee Presidency (E2-22-2356).

Supporting Institution

None

Thanks

None

Romatoid Artritli ve Ankilozan Spondilitli Hastalarda HLA-B27 Antijen Pozitifliği Sıklığı ve HLA-B27 Antijeni ile Diğer Otoantikorlar Arasındaki İlişki

Abstract

Amaç: Bu çalışmanın amacı, romatoid artrit tanılı hastalarda İnsan Lökosit Antijeni (HLA-B27) antijen pozitifliği sıklığını ve romatoid artrit (RA) ve ankilozan spondilit (AS) tanılı hastalarda HLA-B27 pozitifliği ile diğer otoantikorlar ve tedavi arasındaki ilişkiyi araştırmaktır.
Gereç ve Yöntem: Ocak 2017-Eylül 2022 tarihleri arasında Fiziksel Tıp ve Rehabilitasyon polikliniğinde yapılan tetkikler sonucunda RA ve AS tanısı alan hastalar retrospektif olarak tarandı ve HLA-B27 antijeni bakılanlar çalışmaya alındı. Hastaların yaşı, cinsiyeti, HLA-B27 antijen incelemesi sırasında Sedimantasyon (SED) ve C-reaktif protein (CRP) değerleri, Romatoid Faktör (RF), Anti-CCP, Anti-nükleer antikor (ANA), HLA-B27 sonuçları, AS tanısı alan hastalarda sakroiliak Manyetik Rezonans (MR) sonuçları ve verilen ilaç tedavileri kaydedildi.
Bulgular: : Çalışmaya RA’lı 199 ve AS’li 370 olmak üzere toplam 569 hasta dahil edildi. HLA-B27 RA’lı hastaların %11’inde pozitif bulunurken AS’li hastalarda %37.5 idi ve gruplar arasında anlamlı fark vardı. Otoantikorların HLA-B27 ile korelasyonunu analiz ettiğimizde, HLA-B27’ nin RF, Anti-CCP veya ANA ile korele olmadığını bulduk. HLA-B27 ile tedavi yöntemi arasındaki ilişkiyi incelediğimizde, HLA-B27 ile tedavi yöntemi arasında anlamlı bir ilişki yoktu.
Sonuç: Literatürde genel popülasyonda HLA-B27 pozitifliği %5 iken biz 199 RA hastasında %11 pozitif bulduk. Bu çalışma, sanılanın aksine yeni AS tanısı alan hastalarda HLA-B27 pozitifliğinin çok yaygın olmadığını göstermesi açısından önemlidir. RA ve AS’de HLA-B27 sıklığını ve prognoza etkisini değerlendirmek için hasta sayısının daha çok olduğu çalışmalar gereklidir.

Keywords

Ankilozan Spondilit, HLA-B27 antijeni, otoantikorların korelasyonu, Romatoid Artrit

References

• Scott D, Wolfe F, Huizinga T. Rheumatoid arthritis. Lancet. Elsevier Ltd; 2010.
• Silman AJ, Pearson JE. Epidemiology and genetics of rheumatoid arthritis. Arthritis research & therapy. 2002;4(3):1-8.
• Tuncer T, Gilgil E, Kaçar C, et al. Prevalence of rheumatoid arthritis and spondyloarthritis in Turkey: A nationwide study. Archives of rheumatology. 2018;33(2):128.
• Dalvi SK, Shinde SB. Functional assessment tools for ankylosing spondylitis: A systematic review. DPU’s Journal of Ayurved, Homeopathy and Allied Health Sciences. 2022;1(1):24.
• Crossfield SS, Marzo-Ortega H, Kingsbury SR, Pujades- Rodriguez M, Conaghan PG. Changes in ankylosing spondylitis incidence, prevalence and time to diagnosis over two decades. RMD open. 2021;7(3):e001888.
• Zhao J, Huang C, Huang H, et al. Prevalence of ankylosing spondylitis in a Chinese population: a systematic review and meta-analysis. Rheumatology International. 2020;40(6):859-872.
• Khan MA. An update on the genetic polymorphism of HLA-B* 27 with 213 alleles encompassing 160 subtypes (and still counting). Current rheumatology reports. 2017;19(2):1-7.
• Ziade NR. HLA B27 antigen in Middle Eastern and Arab countries: systematic review of the strength of association with axial spondyloarthritis and methodological gaps. BMC Musculoskeletal Disorders. 2017;18(1):1-5.
• Kapitány A, Zilahi E, Szántó S, et al. Association of Rheumatoid Arthritis with HLA‐DR1 and HLA‐DR4 in Hungary. Annals of the New York Academy of Sciences. 2005;1051(1):263-270.
• Matsubara Y, Nakamura Y, Tomita T. 1267 Prevalence and HLA-B27 Positivity Rate among Patients with Ankylosing Spondylitis/ Non-Radiographic Axial Spondyloarthritis in Japan. International Journal of Epidemiology. 2021;50(Supplement_1):dyab168. 423.
• 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.
• Özdemirel Ae, Tecer D, Torgutalp Şş, Küçükşahin O. Prevalence of HLA-B27 in Turkish Patients with Ankylosing Spondylitis and Non-radiographic Axial Spondyloarthritis. Journal of Physical Medicine & Rehabilitation Sciences/Fiziksel Tup ve Rehabilitasyon Bilimleri Dergisi. 2021;24(1)
• Ahmadi SA, Mohammadrezaei-Khorramabadi R, Abbaszadeh S, Rezaian J, Shahsavar F. HLA-B27 is a Risk Factor for Rheumatoid Arthritis: Suggestion for an Evidence-based Update. Current Pharmacogenomics and Personalized Medicine (Formerly Current Pharmacogenomics). 2020;17(1):7-10.
• Kay J, Upchurch KS. ACR/EULAR 2010 rheumatoid arthritis classification criteria. Rheumatology. 2012;51(suppl_6):vi5-vi9.
• Linden SVD, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. Arthritis & Rheumatism. 1984;27(4):361-368.
• Rudwaleit Mv, van der Heijde D, Landewé R, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Annals of the rheumatic diseases. 2011;70(1):25-31.
• Almutairi K, Nossent J, Preen D, Keen H, Inderjeeth C. The global prevalence of rheumatoid arthritis: a meta-analysis based on a systematic review. Rheumatology international. 2021;41(5):863-877.
• Almutairi KB, Nossent JC, Preen DB, Keen HI, Inderjeeth CA. The prevalence of rheumatoid arthritis: a systematic review of population-based studies. The Journal of rheumatology. 2021;48(5):669-676.
• Nilsson J, Andersson ML, Hafström I, et al. Influence of age and sex on disease course and treatment in rheumatoid arthritis. Open access rheumatology: research and reviews. 2021:123-138.
• Chen H-H, Chen Y-M, Lai K-L, et al. Gender difference in ASAS HI among patients with ankylosing spondylitis. PloS one. 2020;15(7):e0235678.
• Jung 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. Journal of Korean medical science. 2010;25(4):532-535.
• Yang 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(5):338-343.
• Arévalo M, Gratacós Masmitjà J, Moreno M, et al. Influence of HLA-B27 on the ankylosing spondylitis phenotype: results from the REGISPONSER database. Arthritis research & therapy. 2018;20:1-6.
• Omar D, Qian M, Almansoub H, 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.
• Mathieu A, Paladini F, Vacca A, Cauli A, Fiorillo MT, Sorrentino R. The interplay between the geographic distribution of HLA-B27 alleles and their role in infectious and autoimmune diseases: a unifying hypothesis. Autoimmunity reviews. 2009;8(5):420- 425.
• Zochling J, van der Heijde D, Burgos-Vargas R, et al. ASAS/ EULAR recommendations for the management of ankylosing spondylitis. Annals of the rheumatic diseases. 2006;65(4):442- 452.
• Khan MA. Polymorphism of HLA-B27: 105 subtypes currently known. Current rheumatology reports. 2013;15(10):1-6.
• Acar M, Cora T, Tunc R, Acar H. HLA-B27 subtypes in Turkish patients with ankylosing spondylitis and healthy controls. Rheumatology international. 2012;32(10):3103-3105.
• Birinci A, Bilgici A, Kuru O, Durupinar B. HLA-B27 polymorphism in Turkish patients with ankylosing spondylitis. Rheumatology international. 2006;26(4):285-287.
• Chen HM, Hsieh RP, Yang H, Kuo YS, Kuo MYP, Chiang CP. HLA typing in Taiwanese patients with oral submucous fibrosis. Journal of oral pathology & medicine. 2004;33(4):191-199.
• Burmester G-R, Dörner T, Sieper J. Spondyloarthritis and chronic idiopathic arthropathies. The autoimmune diseases. Elsevier; 2006:437-452.