J Rheum Dis.  2016 Aug;23(4):234-240. 10.4078/jrd.2016.23.4.234.

Human Leukocyte Antigen B27 and Juvenile Idiopathic Arthritis and Classification of Juvenile Spondyloarthropathies by the Assessment of SpondyloArthritis International Society Criteria

• Eom SN
• Seo AD
• Kim KN

• KMID: 2352466
• DOI: http://doi.org/10.4078/jrd.2016.23.4.234

Abstract

OBJECTIVE
We examined the clinical relationship between human leukocyte antigen B27 (HLA-B27) and juvenile idiopathic arthritis (JIA). Additionally, we assessed the usefulness of the Assessment of SpondyloArthritis International Society (ASAS) criteria for diagnosing juvenile spondyloarthropathies (SpA).
METHODS
We retrospectively reviewed medical records of 239 patients with JIA classified according to the International League of Associations for Rheumatology (ILAR) classification to analyze the features of the joint involvement site. Results were correlated with the presence of HLA-B27. After that, we classified the 239 JIA patients according to the ASAS criteria to diagnose juvenile SpA. The relationship between the ASAS criteria and a diagnosis of juvenile SpA was analyzed by a chi-squared test.
RESULTS
Back pain was associated with HLA-B27 in boys (p=0.002) but not in girls (p=0.616). In both sexes, involvement of the small joints in the lower extremities was highly associated with HLA-B27 (p=0.001 for boys, p=0.021 for girls). In addition, HLA-B27 was associated with enthesitis (p=0.004 for boys, p=0.021 for girls). Eighty-seven (36.4%) patients with JIA fulfilled the ASAS criteria; 2 (0.8%) had axial SpA and 85 (35.6%) had peripheral SpA. HLA-B27 was the most significant factor for diagnosing juvenile SpA (sensitivity 80%, specificity 99.31%, positive likelihood ratio, 116).
CONCLUSION
The ILAR criteria have some weaknesses for diagnosing HLA-B27-positive JIA patients in early stages. The use of the ASAS criteria for juvenile patients will enable pediatric rheumatologists to diagnose juvenile SpA patients earlier.

Keyword

Juvenile arthritis; HLA-B27 antigen; Ankylosing spondylitis; Spondylarthropathies

MeSH Terms

Arthritis, Juvenile*
Back Pain
Classification*
Diagnosis
Female
HLA-B27 Antigen
Humans*
Joints
Leukocytes*
Lower Extremity
Medical Records
Retrospective Studies
Rheumatology
Sensitivity and Specificity
Spondylarthropathies*
Spondylitis, Ankylosing
HLA-B27 Antigen

Reference

1. Cassidy JT, Petty RE, Laxer R, Lindsley C. Textbook of pediatric rheumatology. 6th ed.Philadelphia: Elesevier Saunders;2011. p. 211.

2. Shim YS, Kim JS, Lee KK, Lee KM, Kim KN. Juvenile rheumatoid arthritis in children with ebstein-barr virus infection. J Rheum Dis. 2012; 19:19–24.

3. Nepom B. The immunogenetics of juvenile rheumatoid arthritis. Rheum Dis Clin North Am. 1991; 17:825–42.

4. Petty RE. Etiology and pathogenesis of rheumatic diseases of adolescence. Adolesc Med. 1998; 9:11–24.

5. Queiro R, Torre JC, González TJC, López-Larrea C, Tinturé T, López-Lagunas I. HLA antigens may influence the age of onset of psoriasis and psoriatic arthritis. J Rheumatol. 2003; 30:505–7.

6. Queiro R, Sarasqueta C, Belzunegui J, Gonzalez C, Figueroa M, Torre-Alonso JC. Psoriatic spondyloarthropathy: a comparative study between HLA-B27 positive and HLA-B27 negative disease. Semin Arthritis Rheum. 2002; 31:413–8.

7. Gensler L, Davis JC Jr. Recognition and treatment of juvenile-onset spondyloarthritis. Curr Opin Rheumatol. 2006; 18:507–11.

8. Gmuca S, Weiss PF. Juvenile spondyloarthritis. Curr Opin Rheumatol. 2015; 27:364–72.

9. Jacobs JC, Berdon WE, Johnston AD. HLA-B27-associated spondyloarthritis and enthesopathy in childhood: clinical, pathologic, and radiographic observations in 58 patients. J Pediatr. 1982; 100:521–8.

10. Hall MA, Burgos Vargos R, Ansell BM. Sacroiliitis in juvenile chronic arthritis. A 10-year follow-up. Clin Exp Rheumatol. 1987; 5(Suppl 1):S65–7.

11. Prieur AM. HLA B27 associated chronic arthritis in children: review of 65 cases. Scand J Rheumatol Suppl. 1987; 66:51–6.

12. Burgos-Vargas R, Clark P. Axial involvement in the seronegative enthesopathy and arthropathy syndrome and its progression to ankylosing spondylitis. J Rheumatol. 1989; 16:192–7.

13. Cabral DA, Oen KG, Petty RE. SEA syndrome revisited: a longterm followup of children with a syndrome of seronegative enthesopathy and arthropathy. J Rheumatol. 1992; 19:1282–5.

14. Berntson L, Damgård M, Andersson-Gäre B, Herlin T, Nielsen S, Nordal E, et al. HLA-B27 predicts a more extended disease with increasing age at onset in boys with juvenile idiopathic arthritis. J Rheumatol. 2008; 35:2055–61.

15. Amor B, Dougados M, Mijiyawa M. [Criteria of the classification of spondylarthropathies]. Rev Rhum Mal Osteoartic. 1990; 57:85–9. In French.

16. Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991; 34:1218–27.

17. Petty RE, Southwood TR, Baum J, Bhettay E, Glass DN, Manners P, et al. Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol. 1998; 25:1991–4.

18. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004; 31:390–2.

19. Tse SM, Laxer RM. New advances in juvenile spondyloarthritis. Nat Rev Rheumatol. 2012; 8:269–79.

20. Schaller JG, Ochs HD, Thomas ED, Nisperos B, Feigl P, Wedgwood RJ. Histocompatibility antigens in child-hood-onset arthritis. J Pediatr. 1976; 88:926–30.

21. Murray KJ, Moroldo MB, Donnelly P, Prahalad S, Passo MH, Giannini EH, et al. Age-specific effects of juvenile rheumatoid arthritis-associated HLA alleles. Arthritis Rheum. 1999; 42:1843–53.

22. Gran JT, Mellby AS, Husby G. The prevalence of HLA-B27 in northern Norway. Scand J Rheumatol. 1984; 13:173–6.

23. Pruunsild C, Uibo K, Liivamägi H, Tarraste S, Talvik T, Pelkonen P. Incidence of juvenile idiopathic arthritis in children in Estonia: a prospective population-based study. Scand J Rheumatol. 2007; 36:7–13.

24. Moe N, Rygg M. Epidemiology of juvenile chronic arthritis in northern Norway: a ten-year retrospective study. Clin Exp Rheumatol. 1998; 16:99–101.

25. Wu CJ, Huang JL, Yang MH, Yan DC, Ou LS, Ho HH. Clinical characteristics of juvenile rheumatoid arthritis in Taiwan. J Microbiol Immunol Infect. 2001; 34:211–4.

26. Fujikawa S, Okuni M. Clinical analysis of 570 cases with juvenile rheumatoid arthritis: results of a nationwide retrospective survey in Japan. Acta Paediatr Jpn. 1997; 39:245–9.

27. Boyko Y. Clinical immunology HLA B27 association in children with juvenile idiopathic arthritis: a clinical study of 72 patients. Centr Eur J Immunol. 2009; 34:171–5.

28. Burgos-Vargas R, Vázquez-Mellado J. The early clinical recognition of juvenile-onset ankylosing spondylitis and its differentiation from juvenile rheumatoid arthritis. Arthritis Rheum. 1995; 38:835–44.

29. Sheerin KA, Giannini EH, Brewer EJ Jr, Barron KS. HLA-B27-associated arthropathy in childhood: long-term clinical and diagnostic outcome. Arthritis Rheum. 1988; 31:1165–70.

30. Cassidy JT, Levinson JE, Bass JC, Baum J, Brewer EJ Jr, Fink CW, et al. A study of classification criteria for a diagnosis of juvenile rheumatoid arthritis. Arthritis Rheum. 1986; 29:274–81.

31. Burgos-Vargas R. The Assessment of the Spondyloarthritis International Society concept and criteria for the classification of axial spondyloarthritis and peripheral spondyloarthritis: a critical appraisal for the pediatric rheumatologist. Pediatr Rheumatol Online J. 2012; 10:14.