Association between HLA-B27 and peripheral spondyloarthritis phenotype: results from the ASAS perSpA study

RMD Open. 2022 Dec;8(2):e002696. doi: 10.1136/rmdopen-2022-002696.


Objective: To analyse the influence of HLA-B27 in the phenotypical expression of peripheral spondyloarthritis (pSpA).

Method: This is an observational cross-sectional study using data from the Assessment of SpondyloArthritis international Society perSpA registry, including all patients with an available HLA-B27 test result and with a diagnosis of pSpA or psoriatic arthritis (PsA) as per rheumatologist's judgement. Demographic and clinical data, presence of extra musculoskeletal manifestations (EMM) and fibromyalgia were the variables included in a simple and multiple logistic regression model to assess their association to HLA-B27 positivity.

Results: From the 4465 patients included in the registry, 790 were classified as having either pSpA or PsA and had the HLA-B27 typing available. HLA-B27-positive patients presented a male predominance, had an earlier disease onset and a shorter diagnostic delay compared with the negatives. HLA-B27-positive patients presented a higher frequency of axial involvement, radiographic sacroiliitis, enthesitis and uveitis. Also, root joint involvement, poliarticular joint patern and tarsitis were significantly higher within HLA-B27-positive patients. Furthermore, we did not observe any association between the presence of HLA-B27 and peripheral joint damage, dactylitis, other EMM (psoriasis, inflammatory bowel disease) or fibromyalgia.The multivariable analysis confirmed the independent association of HLA-B27 positivity with male sex, an earlier onset of the disease, the presence of axial involvement, tarsitis and uveitis.

Summary: In summary, the presence of HLA-B27 in pSpA patients was associated with earlier disease onset and higher axial involvement, tarsitis and uveitis, but not with other EMM, fibromyalgia or peripheral structural damage.

Keywords: Arthritis; Spondylitis, Ankylosing; Synovitis.

Publication types

  • Observational Study

MeSH terms

  • Arthritis, Psoriatic* / diagnosis
  • Arthritis, Psoriatic* / epidemiology
  • Arthritis, Psoriatic* / genetics
  • Cross-Sectional Studies
  • Delayed Diagnosis
  • Female
  • Fibromyalgia* / complications
  • Fibromyalgia* / diagnosis
  • Fibromyalgia* / genetics
  • HLA-B27 Antigen / genetics
  • Humans
  • Male
  • Phenotype
  • Spondylarthritis* / complications
  • Spondylarthritis* / diagnosis
  • Spondylarthritis* / genetics
  • Uveitis* / complications


  • HLA-B27 Antigen