Is a positive family history of spondyloarthritis relevant for diagnosing axial spondyloarthritis once HLA-B27 status is known?

Miranda van Lunteren, Désirée van der Heijde, Alexandre Sepriano, Inger J. Berg, Maxime Dougados, Laure Gossec, Lennart Jacobsson, Roberta Ramonda, Martin Rudwaleit, Joachim Sieper, Robert Landewé, Floris A. van Gaalen

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: A positive family history (PFH) of spondyloarthritis, in particular a PFH of AS or acute anterior uveitis, is associated with HLA-B27 carriership in chronic back pain patients. As it is unknown, the study aimed to investigate if a PFH contributes to diagnosing axial spondyloarthritis (axSpA) once HLA-B27 status is known. METHODS: In axSpA-suspected patients from the Assessment of SpondyloArthritis international Society (ASAS), DEvenir des Spondyloarthropathies Indifférenciéés Récentes (DESIR) and SPondyloArthritis Caught Early (SPACE) cohorts, logistic regression analyses were performed with HLA-B27 status and PFH according to the ASAS definition (ASAS-PFH) as determinants and clinical axSpA diagnosis as outcome at baseline. Analyses were repeated with a PFH of AS or acute anterior uveitis. RESULTS: In total, 1818 patients suspected of axSpA were analysed (ASAS n = 594, DESIR n = 647, and SPACE n = 577). In patients from the ASAS, DESIR and SPACE cohorts, respectively 23%, 39% and 38% had an ASAS-PFH, 52%, 58% and 43% were HLA-B27 positive, and 62%, 47% and 54% were diagnosed with axSpA. HLA-B27 was independently associated with an axSpA diagnosis in each cohort but an ASAS-PFH was not [ASAS cohort: HLA-B27 odds ratio (OR): 6.9 (95% CI: 4.7, 10.2), ASAS-PFH OR: 0.9 (95% CI: 0.6, 1.4); DESIR: HLA-B27 OR: 2.1 (95% CI: 1.5, 2.9), ASAS-PFH OR: 1.0 (95% CI 0.7, 1.3); SPACE: HLA-B27 OR: 10.4 (95% CI: 6.9, 15.7), ASAS-PFH OR: 1.0 (95% CI: 0.7, 1.5)]. Similar negative results were found for PFH of AS and acute anterior uveitis. CONCLUSION: In three independent cohorts with different ethnical backgrounds, ASAS, DESIR and SPACE, a PFH was not associated independently of HLA-B27 with a diagnosis of axSpA. This indicates that in the vast majority of patients presenting with back pain, a PFH does not contribute to the likelihood of an axSpA diagnosis if HLA-B27 status is known.

Original languageEnglish
Pages (from-to)1649-1654
Number of pages6
JournalRheumatology (Oxford, England)
Volume58
Issue number9
DOIs
Publication statusPublished - 1 Sep 2019

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HLA-B27 Antigen
Spondylarthropathies
Odds Ratio
Anterior Uveitis
Back Pain
Chronic Pain

Keywords

  • axial spondyloarthritis
  • diagnosis
  • family history

Cite this

van Lunteren, Miranda ; van der Heijde, Désirée ; Sepriano, Alexandre ; Berg, Inger J. ; Dougados, Maxime ; Gossec, Laure ; Jacobsson, Lennart ; Ramonda, Roberta ; Rudwaleit, Martin ; Sieper, Joachim ; Landewé, Robert ; van Gaalen, Floris A. / Is a positive family history of spondyloarthritis relevant for diagnosing axial spondyloarthritis once HLA-B27 status is known?. In: Rheumatology (Oxford, England). 2019 ; Vol. 58, No. 9. pp. 1649-1654.
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title = "Is a positive family history of spondyloarthritis relevant for diagnosing axial spondyloarthritis once HLA-B27 status is known?",
abstract = "OBJECTIVES: A positive family history (PFH) of spondyloarthritis, in particular a PFH of AS or acute anterior uveitis, is associated with HLA-B27 carriership in chronic back pain patients. As it is unknown, the study aimed to investigate if a PFH contributes to diagnosing axial spondyloarthritis (axSpA) once HLA-B27 status is known. METHODS: In axSpA-suspected patients from the Assessment of SpondyloArthritis international Society (ASAS), DEvenir des Spondyloarthropathies Indiff{\'e}renci{\'e}{\'e}s R{\'e}centes (DESIR) and SPondyloArthritis Caught Early (SPACE) cohorts, logistic regression analyses were performed with HLA-B27 status and PFH according to the ASAS definition (ASAS-PFH) as determinants and clinical axSpA diagnosis as outcome at baseline. Analyses were repeated with a PFH of AS or acute anterior uveitis. RESULTS: In total, 1818 patients suspected of axSpA were analysed (ASAS n = 594, DESIR n = 647, and SPACE n = 577). In patients from the ASAS, DESIR and SPACE cohorts, respectively 23{\%}, 39{\%} and 38{\%} had an ASAS-PFH, 52{\%}, 58{\%} and 43{\%} were HLA-B27 positive, and 62{\%}, 47{\%} and 54{\%} were diagnosed with axSpA. HLA-B27 was independently associated with an axSpA diagnosis in each cohort but an ASAS-PFH was not [ASAS cohort: HLA-B27 odds ratio (OR): 6.9 (95{\%} CI: 4.7, 10.2), ASAS-PFH OR: 0.9 (95{\%} CI: 0.6, 1.4); DESIR: HLA-B27 OR: 2.1 (95{\%} CI: 1.5, 2.9), ASAS-PFH OR: 1.0 (95{\%} CI 0.7, 1.3); SPACE: HLA-B27 OR: 10.4 (95{\%} CI: 6.9, 15.7), ASAS-PFH OR: 1.0 (95{\%} CI: 0.7, 1.5)]. Similar negative results were found for PFH of AS and acute anterior uveitis. CONCLUSION: In three independent cohorts with different ethnical backgrounds, ASAS, DESIR and SPACE, a PFH was not associated independently of HLA-B27 with a diagnosis of axSpA. This indicates that in the vast majority of patients presenting with back pain, a PFH does not contribute to the likelihood of an axSpA diagnosis if HLA-B27 status is known.",
keywords = "axial spondyloarthritis, diagnosis, family history",
author = "{van Lunteren}, Miranda and {van der Heijde}, D{\'e}sir{\'e}e and Alexandre Sepriano and Berg, {Inger J.} and Maxime Dougados and Laure Gossec and Lennart Jacobsson and Roberta Ramonda and Martin Rudwaleit and Joachim Sieper and Robert Landew{\'e} and {van Gaalen}, {Floris A.}",
year = "2019",
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language = "English",
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issn = "1462-0332",
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}

van Lunteren, M, van der Heijde, D, Sepriano, A, Berg, IJ, Dougados, M, Gossec, L, Jacobsson, L, Ramonda, R, Rudwaleit, M, Sieper, J, Landewé, R & van Gaalen, FA 2019, 'Is a positive family history of spondyloarthritis relevant for diagnosing axial spondyloarthritis once HLA-B27 status is known?', Rheumatology (Oxford, England), vol. 58, no. 9, pp. 1649-1654. https://doi.org/10.1093/rheumatology/kez095

Is a positive family history of spondyloarthritis relevant for diagnosing axial spondyloarthritis once HLA-B27 status is known? / van Lunteren, Miranda; van der Heijde, Désirée; Sepriano, Alexandre; Berg, Inger J.; Dougados, Maxime; Gossec, Laure; Jacobsson, Lennart; Ramonda, Roberta; Rudwaleit, Martin; Sieper, Joachim; Landewé, Robert; van Gaalen, Floris A.

In: Rheumatology (Oxford, England), Vol. 58, No. 9, 01.09.2019, p. 1649-1654.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Is a positive family history of spondyloarthritis relevant for diagnosing axial spondyloarthritis once HLA-B27 status is known?

AU - van Lunteren, Miranda

AU - van der Heijde, Désirée

AU - Sepriano, Alexandre

AU - Berg, Inger J.

AU - Dougados, Maxime

AU - Gossec, Laure

AU - Jacobsson, Lennart

AU - Ramonda, Roberta

AU - Rudwaleit, Martin

AU - Sieper, Joachim

AU - Landewé, Robert

AU - van Gaalen, Floris A.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - OBJECTIVES: A positive family history (PFH) of spondyloarthritis, in particular a PFH of AS or acute anterior uveitis, is associated with HLA-B27 carriership in chronic back pain patients. As it is unknown, the study aimed to investigate if a PFH contributes to diagnosing axial spondyloarthritis (axSpA) once HLA-B27 status is known. METHODS: In axSpA-suspected patients from the Assessment of SpondyloArthritis international Society (ASAS), DEvenir des Spondyloarthropathies Indifférenciéés Récentes (DESIR) and SPondyloArthritis Caught Early (SPACE) cohorts, logistic regression analyses were performed with HLA-B27 status and PFH according to the ASAS definition (ASAS-PFH) as determinants and clinical axSpA diagnosis as outcome at baseline. Analyses were repeated with a PFH of AS or acute anterior uveitis. RESULTS: In total, 1818 patients suspected of axSpA were analysed (ASAS n = 594, DESIR n = 647, and SPACE n = 577). In patients from the ASAS, DESIR and SPACE cohorts, respectively 23%, 39% and 38% had an ASAS-PFH, 52%, 58% and 43% were HLA-B27 positive, and 62%, 47% and 54% were diagnosed with axSpA. HLA-B27 was independently associated with an axSpA diagnosis in each cohort but an ASAS-PFH was not [ASAS cohort: HLA-B27 odds ratio (OR): 6.9 (95% CI: 4.7, 10.2), ASAS-PFH OR: 0.9 (95% CI: 0.6, 1.4); DESIR: HLA-B27 OR: 2.1 (95% CI: 1.5, 2.9), ASAS-PFH OR: 1.0 (95% CI 0.7, 1.3); SPACE: HLA-B27 OR: 10.4 (95% CI: 6.9, 15.7), ASAS-PFH OR: 1.0 (95% CI: 0.7, 1.5)]. Similar negative results were found for PFH of AS and acute anterior uveitis. CONCLUSION: In three independent cohorts with different ethnical backgrounds, ASAS, DESIR and SPACE, a PFH was not associated independently of HLA-B27 with a diagnosis of axSpA. This indicates that in the vast majority of patients presenting with back pain, a PFH does not contribute to the likelihood of an axSpA diagnosis if HLA-B27 status is known.

AB - OBJECTIVES: A positive family history (PFH) of spondyloarthritis, in particular a PFH of AS or acute anterior uveitis, is associated with HLA-B27 carriership in chronic back pain patients. As it is unknown, the study aimed to investigate if a PFH contributes to diagnosing axial spondyloarthritis (axSpA) once HLA-B27 status is known. METHODS: In axSpA-suspected patients from the Assessment of SpondyloArthritis international Society (ASAS), DEvenir des Spondyloarthropathies Indifférenciéés Récentes (DESIR) and SPondyloArthritis Caught Early (SPACE) cohorts, logistic regression analyses were performed with HLA-B27 status and PFH according to the ASAS definition (ASAS-PFH) as determinants and clinical axSpA diagnosis as outcome at baseline. Analyses were repeated with a PFH of AS or acute anterior uveitis. RESULTS: In total, 1818 patients suspected of axSpA were analysed (ASAS n = 594, DESIR n = 647, and SPACE n = 577). In patients from the ASAS, DESIR and SPACE cohorts, respectively 23%, 39% and 38% had an ASAS-PFH, 52%, 58% and 43% were HLA-B27 positive, and 62%, 47% and 54% were diagnosed with axSpA. HLA-B27 was independently associated with an axSpA diagnosis in each cohort but an ASAS-PFH was not [ASAS cohort: HLA-B27 odds ratio (OR): 6.9 (95% CI: 4.7, 10.2), ASAS-PFH OR: 0.9 (95% CI: 0.6, 1.4); DESIR: HLA-B27 OR: 2.1 (95% CI: 1.5, 2.9), ASAS-PFH OR: 1.0 (95% CI 0.7, 1.3); SPACE: HLA-B27 OR: 10.4 (95% CI: 6.9, 15.7), ASAS-PFH OR: 1.0 (95% CI: 0.7, 1.5)]. Similar negative results were found for PFH of AS and acute anterior uveitis. CONCLUSION: In three independent cohorts with different ethnical backgrounds, ASAS, DESIR and SPACE, a PFH was not associated independently of HLA-B27 with a diagnosis of axSpA. This indicates that in the vast majority of patients presenting with back pain, a PFH does not contribute to the likelihood of an axSpA diagnosis if HLA-B27 status is known.

KW - axial spondyloarthritis

KW - diagnosis

KW - family history

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U2 - 10.1093/rheumatology/kez095

DO - 10.1093/rheumatology/kez095

M3 - Article

VL - 58

SP - 1649

EP - 1654

JO - Rheumatology (Oxford, England)

JF - Rheumatology (Oxford, England)

SN - 1462-0332

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