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Association of HLA–B 27 in Enthesitis Related Arthritis, A Subset of Juvenile Idiopathic Arthritis.

ANURADHA VENUGOPALAN, VINAYA K, YOGITA G, KALPANA J, ARVIND CHOPRA.
CENTER FOR RHEUMATIC DISEASES, INTERDISCIPLINARY SCHOOL OF HEALTH SCIENCE, UNIVERSITY OF PUNE.

Pauciarticular/oligoarthicular onset arthritis (OLA) and enthesitis related arthritis (EnA), the two major groups in the Edmonton ILAR classification 2001 (revised) of Juvenile Idiopathic Arthritis (JIA), have a strong association with the Human Leucocyte Antigen (HLA) – B27 allele. There is sparse data on the prevalence of HLA-B27 in Indian JIA.

Out of a large cohort of JIA, we chose the initial 64 (M = 57; F = 7) patients with seronegative inflammatory arthritis for detail evaluation, including HLA-B27 typing. Systemic arthritis and polyarthritis were excluded. HLA-B27 testing was done by Amplification Refractory Mutation System – Polymerase Chain Reaction (ARMS-PCR).

The patients were classified into EnA =49 and OLA=15. Median age of onset was 13 years and 9.5 years in EnA and OLA respectively. HLA-B27 was positive in 39 patients (80%) of EnA and 4 patients (27%) of OLA
We present the overall clinical and immuno-genetic profile of the subjects in the current study.

 
EnA
OLA
 
Total N=49
HLA-B27+ N=39
Total N=15
HLA-B27+ N=4
Sacroilitis
41(84)
34(87)
6(40)
1(25)
Inflammatory Spondylitis
35(71)
31(79)
8(53)
2(50)
Enthesitis 27(55) 20(51) 1(13) 1(25)
Peripheral arthritis 49(100) 39(100) 14(93) 4(100)
Ocular involvement 7(14) 6(15) 3(20) 1(25)
Family History of B27 positivity 15(31) 12(31) 1(7) 1(25)

Percentage in parenthesis

 

Conclusions

HLA-B27 is positive in about 80% of children with EnA and appears to be associated with both axial involvement and peripheral arthritis.

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