Psoriatic spondyloarthropathy: A comparative study between HLA-B27 positive and HLA-B27 negative disease*

https://doi.org/10.1053/sarh.2002.33470Get rights and content

Abstract

Objectives: To evaluate the relative contribution of the human leukocyte antigen (HLA)-B27 to psoriatic spondyloarthropathy (PsSpA) susceptibility and to analyze whether this antigen contributes to disease expression. Methods: This cross-sectional study included 70 patients (mean age 48 ± 14.5 years; 44 men and 26 women). PsSpA was defined according to radiological findings (grade 2 or more sacroiliitis), and patients were classified into 3 main subtypes: isolated axial disease (n = 16), axial plus oligoarthritis (n = 29) and axial plus polyarthritis (n = 25). All patients were studied following a standard protocol that included the collection of demographic and epidemiological data, clinical history, radiographs, complementary tests, physical examination, and HLA-B27 testing (serological method). For functional evaluation, the Health Assessment Questionnaire-Specific for spondyloarthropathy (HAQ-S) was used. Patients with and without HLA-B27 antigen were compared on the basis of the data. Results: Twenty-four patients (34%) carried the HLA-B27 antigen (RR 6.4, P <.0004). Fifty-six percent of those patients with the isolated axial pattern had this antigen, compared with 24% in the poly-arthritis axial pattern and 31% of those in the oligo-arthritis axial group (P =.016). Univariate analysis demonstrated correlations between HLA-B27 and an earlier age of onset for both psoriasis (P =.028) and arthritis (P =.006), male gender (P =.002), bilateral sacroiliitis (P =.002), and uveitis (P =.026). HLA-B27 negative patients developed more peripheral erosions than HLA-B27 positive patients (P =.05). No correlation was found between B27 and clinical symptoms of back involvement, syndesmophytes, or functional impairment. Conclusions: The HLA-B27 antigen is not only important for PsSpA susceptibility, but also determines some clinical features. This antigen was associated with earlier age of psoriasis and arthritis onset, bilateral sacroiliitis, and male gender. However, it was not associated with either the severity or extension of the spondylitic process or with functional impairment. Semin Arthritis Rheum 31:413-418. Copyright 2002, Elsevier Science (USA). All rights reserved.

Section snippets

Patients and methods

This retrospective cross-sectional study included 70 consecutive patients diagnosed as having PsSpA on the basis of radiological criteria who were recruited at a single university hospital in northern Spain. The majority of them had been included in a previous study, in which the main clinical and epidemiological features of our PsA population were investigated (6). The presence of clear radiographic SI of grade 2 or more according to the New York criteria was mandatory (7). If patients

Results

Of the 70 patients (mean age 48 ± 14.5 years), 44 were men and 26 women (male-to-female [M/F] ratio 7:1). The mean duration of psoriasis was 17 ± 8.6 years, and the duration of arthritis was 12 ± 7 years. The average age at onset of psoriasis was 28 ± 14 years, and of arthritis 35 ± 12 years. The mean latency period between the onset of psoriasis and the first sign of arthritis was 7 ± 6.8 years. A positive family history of dermopathy-arthropathy was recorded in 14 patients (20%). Psoriasis

Discussion

In their initial studies, Moll and Wright identified SpA as a specific pattern of PsA (11). In later years, it became evident that isolated spondylitis in PsA was unusual and that in most cases, it was accompanied by peripheral arthritis 12, 13, 14. Therefore, it is difficult to provide a universally accepted definition of PsSpA, especially because overlap between the different articular subtypes of PsA is common over time 12, 13, 14. Additionally, psoriatic spondylitis may not be noted

References (32)

  • LH Daltroy et al.

    A modification of the Health Assessment Questionnaire for the spondyloarthropathies

    J Rheumatol

    (1990)
  • B Woolf

    On estimating the relation between blood groups and disease

    Ann Hum Genet

    (1955)
  • D Veale et al.

    Classification of clinical subsets in psoriatic arthritis

    Br J Rheumatol

    (1994)
  • P Helliwell et al.

    A re-evaluation of the osteoarticular manifestations of psoriasis

    Br J Rheumatol

    (1991)
  • S Marsal et al.

    Clinical, radiographic and HLA associations as markers for the different patterns of psoriatic arthritis

    Rheumatology

    (1999)
  • SM Kantor et al.

    Clinical and immunogenetic subsets of psoriatic arthritis

    Clin Exp Rheumatol

    (1984)
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    *

    Address reprint requests to R. Queiro, MD, Rheumatology Unit, Hospital San Agustin, Camino de Heros 4, 33400, Avilés-Asturias, Spain. E-mail: [email protected]

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