Date: Sunday, October 21, 2018
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: The Assessment of SpondyloArthritis international Society (ASAS) defines a positive family history (PFH) of spondyloarthritis (SpA) as presence of ankylosing spondylitis (AS), acute anterior uveitis (AAU), reactive arthritis (ReA), inflammatory bowel disease (IBD), and/or psoriasis in first (FDR)- or second (SDR)-degree relatives. In two European cohorts (SPACE and DESIR) a PFH of AS and AAU, but not other subtypes, were associated with HLA-B27 carriership in patients suspected of axial SpA (axSpA)1. As the importance of ethnicity or degree of family relationship is unknown, we investigated the influence of ethnicity, FDR or SDR on the association between a PFH and HLA-B27 carriership in patients suspected of axSpA.
Methods: Univariable analyses were performed among patients suspected of axSpA in the ASAS cohort at baseline. Each disease (AS, AAU, psoriasis, IBD, ReA) in a PFH according to the ASAS definition was a determinant in separate models with HLA-B27 carriership as outcome. Analyses were stratified for self-reported ethnicity (white, Asian, and other), FDR, and SDR. Analyses were repeated in multivariable models to investigate independent associations.
Results: In total, 594 patients were analysed. Patients had a mean (SD) age of 33.7 (11.7) years, 46% were male; 52% was HLA-B27+, 59% were white, 36% were Asian, and 5% had another ethnicity. A PFH was reported by 23% of the patients; a PFH of AS was the most (15%) and PFH of AAU (1%) the least often reported family history among all patients. A PFH in first-degree relatives was reported in 19% of patients and in second-degree relatives in 4%. A PFH was associated with HLA-B27 carriership in patients with a white (OR:2.3, 95%CI:1.4-3.9) or Asian ethnicity (OR:3.1, 95%CI:1.6-5.8) and with a PFH in FDR (OR:2.9, 95%CI:1.8-4.5) , but not with a PFH in SDR (OR:1.7, 95%CI:0.7-3.8) or in other ethnicities (Table 1). A PFH of AS was positively associated with HLA-B27 carriership in all subgroups (white OR:7.1, 95%CI:2.9-17.1; Asian OR:5.7, 95%CI:2.5-13.2; FDR OR:7.8, 95%CI:3.8-16.0; SDR OR:3.7, 95%CI:1.2-11.6). A PFH of AAU, ReA, IBD, or psoriasis was never positively associated with HLA-B27 carriership. In the multivariate analysis, similar results were found.
Conclusion: In the international ASAS cohort, a PFH of AS, but not of AAU, ReA, IBD, or psoriasis, was associated with HLA-B27 carriership irrespective of ethnicity or degree of family relationship. These data, in combination with data from two European cohorts, show that a PFH of AS and possibly a PFH of AAU can be used to identify patients who are more likely to be HLA-B27 positive and therefore have an increased risk of axSpA.
References: 1 Ez-Zaitouni et al (2017), AR&T 2017;19(1):118.
To cite this abstract in AMA style:van Lunteren M, Sepriano A, Landewé RBM, Sieper J, Rudwaleit M, van der Heijde D, van Gaalen F. Do Ethnicity, Degree of Family Relationship, and the Spondyloarthritis Subtype in Affected Relatives Influence the Association between a Positive Family History for Spondyloarthritis and HLA-B27 Carriership? Results from the Worldwide ASAS Cohort [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/do-ethnicity-degree-of-family-relationship-and-the-spondyloarthritis-subtype-in-affected-relatives-influence-the-association-between-a-positive-family-history-for-spondyloarthritis-and-hla-b27-carri/. Accessed July 11, 2020.
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