Clinical Rheumatology

, Volume 17, Issue 2, pp 121–124 | Cite as

HLA B27: A prognostic factor in juvenile chronic arthritis

  • H. A. Savolainen
  • M. Lehtimäki
  • H. Kautiainen
  • K. Aho
  • P. Anttila
Original Article


This study was performed to assess the frequency of HLA B27 in patients with juvenile chronic arthritis (JCA) of varying severity and outcome by studying three patient categories: those in whom cytostatic treatment with azathioprine had been started, those with secondary amyloidosis, and those with arthroplasty of the knee or hip joints. In the first category the frequency of the HLA B27 allele was compared between those who had attained remission and those who had not. In the second and third categories the rate at which amyloidosis developed and the timing for the need of arthroplasty, were compared for HLA B27-positive and-negative patients. A control group consisted of 37 patients with uncomplicated seronegative polyarthritis. Ten of the 37 patients in the control group (27%) were HLA B27 positive as opposed to 84 out of 190 (44%) in the three study groups. Of the 101 patients treated with azathioprine, two out of 15 in remission were HLA B27 positive, whereas as many as 41 out of 86 with still active disease were HLA B27 positive (p=0.013). Of the secondary amyloidosis patients, 29 out of 51 carried HLA B27. The HLA B27-positive patients contracted amyloidosis on average 5.9 (median 6.7) years earlier than the HLA B27-negative patients (p=0.038). Of the arthroplasty patients, 39 out of 91 carried HLA B27. The HLA B27-positive patients underwent arthroplasty on average 2.9 (median 3.5) years earlier than the HLA B27-negative patients (p=0.050). We conclude that HLA B27-positive cases are accumulated among the most severe cases of JCA.


Amyloidosis Arthroplasty HLA B27 Juvenile chronic arthritis Prognosis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Rachelevsky GS, Terasaki PI, Katz R, Stiehm ER. Increased prevalence of W27 in juvenile rheumatoid arthritis. N Engl J Med 1974;290:892–3.PubMedGoogle Scholar
  2. 2.
    Edmonds J, Morris RI, Metzger AL, et al. Follow-up study of juvenile chronic polyarthritis with particular reference to histocompatibility antigen W27. Ann Rheum Dis 1974;33:289–92.PubMedGoogle Scholar
  3. 3.
    Buc M, Nyulassy S, Stefanovic J, Michalko J, Mozolova D. HL-A system and juvenile rheumatoid arthritis. Tissue Antigens 1974;4:395–7.PubMedGoogle Scholar
  4. 4.
    Hall MA, Ansell BM, James DCO, Zylinski P. HL-A antigens in juvenile chronic polyarthritis (Still's disease). Ann Rheum Dis 1975;34 (suppl.):36–8.Google Scholar
  5. 5.
    Hill RH. HL-A antigens in juvenile rheumatoid arthritis. Arthritis Rheum 1977;20:498–9.Google Scholar
  6. 6.
    Gershwin ME, Opelz G, Terasaki PI, Castles JJ, Gorman TA. Frequency of HLA-Dw3 in juvenile rheumatoid arthritis. Tissue Antigens 1977;10:330–6.PubMedGoogle Scholar
  7. 7.
    Dequeker J, Decock T, Walravens M, van de Putte I. A systemic survey of HLA-B27 prevalence in inflammatory rheumatic diseases. J Rheumatol 1978;5:452–9.PubMedGoogle Scholar
  8. 8.
    Mäkelä AL, Tiilikainen A. HLA antigens in children with juvenile rheumatoid arthritis. Laeknabladid 1978;65 (suppl 3):113–5.Google Scholar
  9. 9.
    Arnett FC, Bias WB, Stevens MB. Juvenile-onset chronic arthritis. Clinical and roentgenographic features of a unique HLA-B27 subset. Am J Med 1980;69:369–76.PubMedGoogle Scholar
  10. 10.
    Morling N, Friis J, Heilmann C, et al. HLA antigen frequencies in juvenile chronic arthritis. Scand J Rheumatol 1985;14:209–16.PubMedGoogle Scholar
  11. 11.
    Schuchmann L, Albert ED, Michels H, Renz K. Differenzierung der Juvenilen Chronischen Arthritis (JCA)-Diagnostiche Bedeutung der HLA Assoziationen. Klin Päd 1984;19:355–9.Google Scholar
  12. 12.
    Brunner HI, Ivaskova E, Haas P, et al. Class I associations and frequencies of class II HLA-DRB alleles by RELP analysis in children with rheumatoid-factor-negative juvenile chronic arthritis. Rheumatol Int 1993;13:83–8.PubMedGoogle Scholar
  13. 13.
    Miller ML, Aaron S, Jackson J, et al.. HLA gene frequencies in children and adults with systemic onset juvenile rheumatoid arthritis. Arthritis Rheum 1985;28:146–150.PubMedGoogle Scholar
  14. 14.
    Cassidy JT, Levinson JE, Bass JC, et al. A study of classification criteria for a diagnosis of juvenile rheumatoid arthritis. Arthritis Rheum 1986;29:274–81.PubMedGoogle Scholar
  15. 15.
    Mitsui H, Juji T, Sonozaki H, Seki H., Watanabe N. Distribution of HLA-B27 in patients with juvenile rheumatoid arthritis. Ann Rheum Dis 1977;36:86–7.PubMedGoogle Scholar
  16. 16.
    Nissilä M, Elomaa L, Tiilikainen A. HL-A antigens in juvenile rheumatoid arthritis. N Engl J Med 1975;292:430.PubMedGoogle Scholar
  17. 17.
    Hall PJ, Burman SJ, Barash J, Briggs DC, Ansell BM. HLA and complement C4 antigens in polyarticular onset seronegative juvenile chronic arthritis: association of early onset with HLA-DRw8. J Rheumatol 1989;16:55–9.PubMedGoogle Scholar
  18. 18.
    Bedford PS, Ansell BM, Hall PJ, Woo P. Increased frequency of D4 in children and adults with systemic onset JCA. Clin Exp Rheumatol 1992;10:189–93.PubMedGoogle Scholar
  19. 19.
    Wood PH. Nomenclature and classification of arthritis in children. In: Munthe E. editor. The care of Rheumatic Children. Basel, EULAR;1978:47.Google Scholar
  20. 20.
    van der Linden SM, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis in HLA B27 positive individuals: a comparison of relatives of spondylitis patients with the general population. Arthritis Rheum 1984;27:241–9.PubMedGoogle Scholar
  21. 21.
    Tiitinen S, Kaarela K, Filipowich-Sosnowska, A, et al. HLA typing and seropositivity in Finnish and in Polish patients with rheumatoid arthritis and amyloidosis. Clin Rheumatol 1992;2:265–8.Google Scholar
  22. 22.
    Isomäki H, Koota K, Martio J, et al. HL-A27 and arthritis. Ann Clin Res 1975;7:138–45.PubMedGoogle Scholar
  23. 23.
    Leirisalo-Repo M, Suoranta H. Ten-year followup study of patients withYersinia arthritis. Arthritis Rheum 1988;31:533–7.PubMedGoogle Scholar
  24. 24.
    Westman P, Partanen J, Leirisalo-Repo M, Koskimies S. Different DRB1 04 alleles predominate in the Finnish random population and in HLA-B-27-positive sub-populations. Tissue Antigens 1994;44:329–31.PubMedGoogle Scholar
  25. 25.
    Woo P. Amyloidosis in pediatric rheumatic disease. J Rheumatol 1992;19 (suppl. 35):10–6.Google Scholar
  26. 26.
    Schuchmann L, Michels H, Renaud M, Renz K. Die Amyloidoseeine gefürchtete Folgekrankheit der juvenilen chronischen Arthritis. Klin Päd 1981;193:67–72.Google Scholar
  27. 27.
    Burmann SJ, Hall PJ, Bedford PA, Howard A, Ansell BM. HLA antigen frequencies among patients with juvenile chronic arthritis and amyloidosis: a brief report. Clin Exp Rheumatol 1986; 4:261–3.PubMedGoogle Scholar
  28. 28.
    Lehtimäki MY, Kaarela K, Hämäläinen MMJ. Incidence of hip involvement and need for total hip replacement in rheumatoid arthritis. Scand J Rheumatol 1986;15:387–91.PubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 1998

Authors and Affiliations

  • H. A. Savolainen
    • 1
  • M. Lehtimäki
    • 4
  • H. Kautiainen
    • 2
  • K. Aho
    • 5
  • P. Anttila
    • 3
  1. 1.Department of PediatricsRheumatism Foundation HospitalHeinolaFinland
  2. 2.Department of StatisticsRheumatism Foundation HospitalHeinolaFinland
  3. 3.Department of RadiologyRheumatism Foundation HospitalHeinolaFinland
  4. 4.Department of SurgeryTampere University HospitalTampereFinland
  5. 5.National Public Health InstituteHelsinkiFinland

Personalised recommendations