Ankylosing spondylitis, HLA-B27 positivity and the need for biologic therapies.
OBJECTIVE
HLA-B27 positivity strongly influences Ankylosing spondylitis (AS) disease susceptibility and phenotype. The aim of this study was to analyse an AS cohort with respect to quality of life (ASQoL), extra-articular disease, markers of disease activity (BASDAI), functional capacity (BASFI), biologic requirement, and the influence of HLA-B27 on these parameters.


METHODS
Data recorded in 82 patients included demographics (age, sex), extra-articular disease (GI, ocular, dermatological, GU), cardiac and pulmonary diagnoses. BASDAI, BASFI, ASQoL, joint counts, disease duration and past/present treatment (NSAID, DMARD, steroid and biologic use) were also recorded.


RESULTS
90.2% of the cohort was B27 positive with significantly longer disease duration (17.6 v 6.9 years, p<0.05). BASFI (42.2 v 5.9), BASDAI (3.22 v 1.3), ASQoL (10 v 4), physician assessment of biologic need (24 v 5), steroid (15.7% v 12.5%) and NSAID use (98.6% v 75%) were higher in the B27 positive group, as were ocular (38.9% v 12.5%), pulmonary (4.2% v 0%) and cardiac (4.3% v 0%) features. Negative patients displayed more GI (37.5% v 19.4%), dermatological (25% v 19.7%) and GU (25% v 4.2%) features. Patients satisfying ASAS (AS assessment study group) criteria and receiving biologic therapy were 18.9% (B27 positive group) and 0% (B27 negative group).


CONCLUSIONS
AS patients have significantly longer disease duration if B27 positive, higher markers of disease activity, poorer functional status, poorer quality of life, and more extra-articular manifestations. These findings were reflected in the percentage of patients needing biologic therapies.
Freeston
Jane
J
Academic Department of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Chapel Allerton, Leeds, UK. medjef@leeds.ac.uk <medjef@leeds.ac.uk>
Barkham
Nick
N
Hensor
Elizabeth
E
Emery
Paul
P
Fraser
Alexander
A
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001691:Biological Therapy / Q000379:methods; D015415:Biomarkers / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D015796:HLA-B27 Antigen / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D011788:Quality of Life; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000453:epidemiology / Q000276:immunology* / Q000378:metabolism / Q000628:therapy*; D013256:Steroids / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D006113:United Kingdom / Q000453:epidemiology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D015415:Biomarkers; D015796:HLA-B27 Antigen; D013256:Steroids; D014409:Tumor Necrosis Factor-alpha