HLA-B27 predicts a more chronic disease course in an 8-year followup cohort of patients with juvenile idiopathic arthritis.

Abstract

OBJECTIVE:

We investigated associations of HLA-B27 with clinical manifestations and longterm outcome in a near population-based setting among patients with juvenile idiopathic arthritis (JIA).

METHODS:

We studied clinical and serological data from 410 patients with HLA-B27 results among 440 prospectively collected patients with JIA with 8-year followup data in a Nordic database. The study was structured to be as close to a population-based study as possible.

RESULTS:

HLA-B27 was analyzed in 93% of patients, and was positive in 21% of the cohort, in 18.4% of the girls and in 25.9% of the boys. Boys who were HLA-B27-positive had significantly higher age at onset compared to HLA-B27-negative boys and compared to both HLA-B27-negative and positive girls. This difference in onset age in relation to HLA-B27 was not found in girls. HLA-B27 was associated with clinical signs of sacroiliitis, enthesitis, and tenosynovitis in boys, but not in girls. After 8 years of disease, 46 children (11.2%) were classified as having enthesitis-related arthritis (ERA). Boys with ERA had clinical signs of sacroiliitis more often than girls with ERA. HLA-B27-positive children, as well as children with clinical signs of sacroiliitis, enthesitis, and hip arthritis, had higher odds of not being in remission off medication after 8 years of disease.

CONCLUSION:

In this near population-based Nordic JIA cohort we found significant differences between HLA-B27-positive boys and girls in age at disease onset, clinical signs of sacroiliitis, and ERA classification. HLA-B27 was negatively associated with longterm remission status, possibly because of its association with clinical disease characteristics, such as sacroiliitis, rather than being a general marker of persistent disease.

• Authors: Lillemor Berntson, Ellen Nordal, Kristiina Aalto, Suvi Peltoniemi, Troels Herlin, Marek Zak, Susan Nielsen, Marite Rygg, Nordic Study Group of Paediatric Rheumatology
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 40 Issue 5 Pg. 725-31 (May 2013) ISSN: 0315-162X [Print] Canada
• PMID: 23547219 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• HLA-B27 Antigen

Topics

• Age of Onset
• Arthritis, Juvenile (blood, epidemiology, genetics, pathology)
• Child
• Child, Preschool
• Female
• Finland (epidemiology)
• Genetic Predisposition to Disease
• HLA-B27 Antigen (blood, genetics)
• Humans
• Joints (pathology)
• Male
• Prospective Studies
• Scandinavian and Nordic Countries (epidemiology)
• Severity of Illness Index
• Sex Factors
• Time Factors