Human Leukocyte Antigen B27 (HLA-B27) and Its Association with Spondyloarthritis: Clinical Implications from a Tertiary Healthcare Center in Bangladesh
Rayhan Chowdhury *
Department of Environmental Health and Wash, International Centre for Diarrhoeal Disease Research, Bangladesh.
Md. Mahfuz Al Mubin
Department of Laboratory Medicine, Grameen Medical Services, Sylhet, Bangladesh.
Md. Shafiul Azam
Department of Medical Biotechnology, University of Technology Sydney, Australia.
Firoz Reza
Department of Transfusion Medicine, Dhaka Medical Collage & Hospital, Dhaka, Bangladesh.
Al Imran Rimon
Department of Laboratory Medicine, Central Police Hospital, Dhaka, Bangladesh.
Bijoy Biswas
Department of Laboratory Medicine, United Hospital Limited, Dhaka, Bangladesh.
Tasnim Shamrin
Department of Microbiology, City Dental College and Hospital, Dhaka, Bangladesh.
*Author to whom correspondence should be addressed.
Abstract
Background: Spondyloarthritis (SpA) comprises a group of inflammatory rheumatic diseases characterized by axial and peripheral joint involvement and a strong association with the Human Leukocyte Antigen B27 (HLA-B27). Despite global recognition of HLA-B27 as a key genetic marker in SpA, data regarding its prevalence and clinical relevance in the Bangladeshi population remains limited.
Aim: This study aimed to determine the frequency of HLA-B27 among patients with SpA in Bangladesh and to evaluate its association with clinical features, disease severity, and inflammatory markers.
Methods: A cross-sectional observational study was conducted at a tertiary healthcare center in Dhaka, Bangladesh, from January 2023 to December 2023. A total of 180 patients diagnosed with SpA based on ASAS criteria were enrolled. Clinical data, including symptoms, SpA subtype, and extra-articular manifestations, were recorded. Laboratory tests for HLA-B27 (using RT-PCR), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were performed. Statistical analysis was conducted to assess associations between HLA-B27 status and disease characteristics.
Results: Out of 180 patients diagnosed with spondyloarthritis, 120 (66.7%) were HLA-B27 positive. The highest rate of HLA-B27 positivity was seen in patients with Ankylosing Spondylitis (85%), followed by Psoriatic Arthritis (70%), Reactive Arthritis (65%), and Undifferentiated SpA (60%). HLA-B27-positive patients had a longer mean disease duration (6.8 ± 3.9 years) compared to those who were HLA-B27-negative (4.5 ± 2.1 years). Clinically, HLA-B27-positive individuals experienced significantly higher rates of inflammatory back pain (95% vs. 80%), morning stiffness (92% vs. 75%), peripheral joint involvement (64% vs. 48%), and sacroiliitis (78% vs. 53%). Extra-articular manifestations such as uveitis (18% vs. 7%) and psoriasis (24% vs. 12%) were also more common in the HLA-B27-positive group. Inflammatory markers were markedly elevated, with mean ESR and CRP levels significantly higher in HLA-B27-positive patients (38.0 mm/hr and 18.5 mg/L, respectively) than in HLA-B27-negative patients (27.0 mm/hr and 12.4 mg/L; p < 0.05 for both). These findings suggest that HLA-B27 is strongly associated with more severe disease features and increased inflammatory activity.
Conclusion: The prevalence of HLA-B27 is notably high among Bangladeshi SpA patients and is strongly associated with more severe clinical presentations and higher inflammatory activity. HLA-B27 testing is a valuable diagnostic and prognostic tool, particularly in seronegative cases, and should be integrated into routine clinical practice to improve early diagnosis and personalized treatment strategies.
Keywords: HLA-B27, spondyloarthritis, ankylosing spondylitis, inflammatory markers, Bangladesh