Clinical signficance of human leucocytic antigen (HLA-B27) in patients with early and late-onset axial spondyloarthritis

Abstract

Aim of the work

To compare the clinical, laboratory and radiological features of patients with positive human leucocytic antigen (HLA)-B27 in patients with early-onset (EOSpA) and late-onset (LOSpA) axial spondyloarthritis.

Patients and methods

The study included 195 axial-SpA patients with positive HLA-B27 divided into those ≤45 years (EOSpA) and those >45 years (LOSpA). Characteristics of the patients, medications received as well as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Bath Ankylosing Spondylitis Radiological Index (BASRI), Ankylosing Spondylitis Disease Activity Score (ASDAS) scores were recorded.

Results

The mean age of the patients was 43.6 ± 13.3 years and 121 (62.1 %) were females. Shoulder pain, peripheral arthritis, and adhesive capsulitis were significantly more common in LOSpA (20 %,13.7 % and 5.3 %; p = 0.001, p = 0.017, and p = 0.026) whereas dorsal and low back pain were significantly more prominent in EOSpA (20 % and 61 %; p = 0.011 and p = 0.001). There was a significant difference between the two groups in terms of gender, body mass index (BMI), smoking, anti-tumor necrosis factor (TNF)-α use, C-reactive protein (CRP), BASFI, BASDAI, ASDAS, MASES and BASRI scores (p < 0.001, p < 0.001, p = 0.016, p < 0.001, p < 0.001, p = 0.009, p < 0.001, p = 0.018, p < 0.001, p < 0.001, respectively). On regression analysis, male gender and high CRP were associated with EOSpA (p = 0.011, and p = 0.001), while early-stage sacroiliitis, non-steroidal anti-inflammatory drug (NSAID) use, high BASFI and BASRI were related to LOSpA (p = 0.004, p = 0.003, p < 0.0001 and p < 0.0001).

Conclusion

LOSpA was associated with female gender, peripheral involvement, lower levels of inflammatory markers, higher functional status and disease activity, higher enthesitis and radiological scores, and less use of anti-TNF-α.