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HLA-B27 Predicts a More Extended Disease with Increasing Age at Onset in Boys with Juvenile Idiopathic Arthritis LILLEMOR BERNTSON, MICHAEL DAMGÅRD, BOEL ANDERSSON-GÄRE, TROELS HERLIN, SUSAN NIELSEN, ELLEN NORDAL, MARITE RYGG, MAREK ZAK, and ANDERS FASTH, for the Nordic Paediatric Rheumatology Study Group
ABSTRACT. Methods. We studied an incidence-based cohort of 305 patients collected prospectively in 3 Nordic countries (Sweden, Norway, Denmark). Clinical and serological data of the first 3 years of the disease were collected. Results. HLA-B27 was found to be positive in 25.5% of the patients, and we found a higher proportion of HLA-B27-positive boys with older age at disease onset (p = 0.034). Regression analysis showed a correlation of 0.7 in the HLA-B27-positive boys, pointing to a higher risk of more joint involvement with older age at disease onset. By Fisher's exact test, involvement of small joints in the lower extremities was associated with HLA-B27 in boys (p = 0.011), but not in girls (p = 0.687). HLA-B27 was associated with inflammatory back pain in both sexes (p = 0.041 in boys, p = 0.042 in girls), but with enthesitis only in boys (p < 0.001 in boys, p = 0.708 in girls). Conclusion. HLA-B27 is of increasing importance with older age at disease onset in boys with JIA, predicting more active joints within the first 3 years of disease, and also involving small joints in the lower extremity to a greater degree than in HLA-B27-negative boys. During the first 3 years of disease the occurrence of HLA-B27 is associated with inflammatory back pain in both sexes, but with enthesitis only in boys. Our data present new challenges for the ILAR classification of JIA. (J Rheumatol First Release Sept 1 2008) Key Indexing Terms:
JUVENILE RHEUMATOID ARTHRITIS From the Department of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala; Department of Pediatrics, Falun Hospital, Falun; Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden; Department of Pediatrics, Århus University Hospital, Skejby; University Clinic of Pediatrics II, Rigshospitalet, Copenhagen, Denmark; Institute of Clinical Medicine/Institute of Community Medicine, University of Tromsø, and Department of Pediatrics, University Hospital of North Norway, Tromsø; Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim; Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway; and Department of Pediatrics, Göteborg University, Göteborg, Sweden. Supported by grants from the Department of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, The Queen Silvia Children's Hospital, Göteborg, and the Dalarna Clinical Research Institute, Falun, Sweden; and the Swedish Rheumatism Association and King Gustaf V 80th Jubilee Fund. L. Berntson, MD, PhD, Department of Women's and Children's Health, Uppsala University Children's Hospital; M. Damgård, MD, Department of Pediatrics, Falun Hospital; B. Andersson Gäre, MD, PhD, Department of Pediatrics, Ryhov County Hospital; T. Herlin, MD, PhD, Århus University Hospital; S. Nielsen, MD, University Clinic of Pediatrics II, Rigshospitalet; E. Nordal, MD, Institute of Clinical Medicine/Institute of Community Medicine, University of Tromsø, and Department of Pediatrics, University Hospital of North Norway; M. Rygg, MD, PhD, Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, and Department of Pediatrics, St. Olavs Hospital; M. Zak, MD, University Clinic of Pediatrics II, Rigshospitalet; A. Fasth, MD, PhD, Professor of Pediatric Immunology, Department of Pediatrics, Göteborg University. Address reprint requests to Dr. L. Berntson, Department of Pediatrics, Akademiska University Hospital, SE -75185 Uppsala, Sweden. E-mail: lillemor.berntson@telia.com Accepted for publication May 26, 2008.
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