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The occurrence of sacroiliitis in HLA-B*35-positive patients with undifferentiated spondyloarthritis. A cross sectional MRI study

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Abstract

Objective

To investigate possible association between sacroiliitis and HLA-B*35 positivity.

Method

After excluding patients with axial spondyloarthritis and HLA-B*27 positivity, psoriasis inflammatory bowel disease, preceding infections, or juvenile type of spondyloarthritis, 110 patients were recruited with a diagnosis of undifferentiated axial spondyloarthritis. All of them had inflammatory back pain of short duration (3 months to 2 years) and 72 were HLA-B*35 positive. In order to determine if there is a possible association of sacroiliitis and HLA-B*35 positivity, all patients underwent MRI of sacroiliac joints.

Results

A statistically significant association between the detection of bone marrow edema at sacroiliac joints on MRI and HLA-B*35 positivity (χ2 = 6.25; p = 0.022) was found. A logistic regression analysis revealed that the presence of HLA-B*35 allele was associated with a 6 times greater chance of identifying bone marrow edema at sacroiliac joints on MRI (OR 6, 95% CI 1.3–27, p = 0.021). HLA-B*35 positivity was also associated with a 4.7 times greater chance of finding elevated CRP (OR 4.7, 95% CI 1–11.9, p = 0.047) and a 5 times greater chance of finding peripheral joint synovitis (OR 5, 95% CI 1.75–14.3, p = 0.003). HLA-B*35-positive patients had high disease activity (mean ± SD of Bath Ankylosing Spondylitis Disease Activity Index 6.1 ± 1.72 and Ankylosing Spondylitis Disease Activity Score C-reactive protein Index 3 ± 0.64) with a high degree of functional limitations (mean ± SD of Bath Ankylosing Spondylitis Functional Index 5.3 ± 2.16).

Conclusion

The data clearly show the association between bone marrow edema on MRI at sacroiliac joints and HLA-B*35 allele in patients with undifferentiated spondyloarthritis. Further work is needed to understand how much this result may influence follow-up of these patients.

Key Points

• HLA-B*35 allele was associated with a 6 times greater chance of identifying bone marrow edema at sacroiliac joints on MRI in un-axSpa patients.

• HLA-B*35 allele was also associated with a 4.7 times greater chance of finding elevated CRP and a 5 times greater chance of finding peripheral joint synovitis in un-axSpa patients.

• HLA-B*35 allele could be a potential risk factor for developing sacroiliitis and axSpA.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgments

The authors thank all the study patients and their research enrollers. The authors thank Ana Poljičanin, MD, PhD, for technical support and critical reading of manuscript and Vesna Čapkun for data analysis.

Funding

The study was funded by the personal resources of Daniela Šošo. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Rehabilitation Medicine and Rheumatology, University Hospital Centre Split, Split, Croatia

    Daniela Šošo, Jure Aljinović & Ivanka Marinović

  2. Department of Health Studies, University of Split, Split, Croatia

    Jure Aljinović & Ivanka Marinović

  3. Department of Diagnostic and Interventional Radiology, University Hospital Centre Split, Split, Croatia

    Sanja Lovrić Kojundžić

  4. Department of Transfusion Medicine, University Hospital Centre Split, Split, Croatia

    Esma Čečuk Jeličić

  5. Department of Rheumatology and Clinical Immunology, University Hospital Centre Split, Split, Croatia

    Daniela Marasović Krstulović

Authors
  1. Daniela Šošo
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Contributions

DŠ designed the study protocol, coordinated the clinical study, interpreted the analysis, and completed the first draft of the manuscript. IM was responsible for the acquisition of data. JA performed US examinations. SLK interpreted the MRI examinations of SI joints. EČJ performed HLA typing. DMK supervised all aspects of the study and controlled the decision to publish. All authors contributed to the drafting of the manuscript and final approval of the version to be submitted.

Corresponding author

Correspondence to Daniela Šošo.

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This study was approved by the Ethical Committee of the Clinical Hospital Centre Split (500-03/17-01/08, 2181-147-01/06/M.S.-17-2) in accordance with Helsinki Declaration and other important laws and regulations. All participants have signed informed consent.

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Šošo, D., Aljinović, J., Marinović, I. et al. The occurrence of sacroiliitis in HLA-B*35-positive patients with undifferentiated spondyloarthritis. A cross sectional MRI study. Clin Rheumatol 39, 2299–2306 (2020). https://doi.org/10.1007/s10067-020-04999-4

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