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Abstract
Objective
We examined the clinical relationship between human leukocyte antigen B27 (HLA-B27) and juvenile idiopathic arthritis (JIA). Additionally, we assessed the usefulness of the Assessment of SpondyloArthritis International Society (ASAS) criteria for diagnosing juvenile spondyloarthropathies (SpA).
Methods
We retrospectively reviewed medical records of 239 patients with JIA classified according to the International League of Associations for Rheumatology (ILAR) classification to analyze the features of the joint involvement site. Results were correlated with the presence of HLA-B27. After that, we classified the 239 JIA patients according to the ASAS criteria to diagnose juvenile SpA. The relationship between the ASAS criteria and a diagnosis of juvenile SpA was analyzed by a chi-squared test.
Results
Back pain was associated with HLA-B27 in boys (p=0.002) but not in girls (p=0.616). In both sexes, involvement of the small joints in the lower extremities was highly associated with HLA-B27 (p=0.001 for boys, p=0.021 for girls). In addition, HLA-B27 was associated with enthesitis (p=0.004 for boys, p=0.021 for girls). Eighty-seven (36.4%) patients with JIA fulfilled the ASAS criteria; 2 (0.8%) had axial SpA and 85 (35.6%) had peripheral SpA. HLA-B27 was the most significant factor for diagnosing juvenile SpA (sensitivity 80%, specificity 99.31%, positive likelihood ratio, 116).
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Table 1.
Classification performed at 5 years from disease onset in 239 children with JIA
Table 2.
Sex distribution, age at disease onset and radiographic sacroiliitis in 239 children with JIA
Table 3.
Analysis of children with JIA in relation to joint involvement and HLA-B27 status
Values are presented as number (%). JIA: juvenile idiopathic arthritis, HLA: human leukocyte antigen. Large joint: shoulder, elbow and wrist at upper extremities; knee and ankle at lower extremities. Small joint: midcarpal, carpometacarpal, meta-carpophalangeal, and interphalangeal joints at upper extremities; subtalar, talonavicular, calcaneocuboid, naviculocuneiform, tarsometatarsal, metatarsophalangeal, and interphalangeal joints at lower extremities.
Table 4.
Sensitivity, specificity, PLRs and negative likelihood ratios of clinical and laboratory SpA features in patients classified according to ASAS criteria
Table 5.
Univariate analysis for clinical and laboratory SpA features in patients classified according to ASAS criteria
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