Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors.

OBJECTIVE To determine the overall prevalence of spondylarthropathy (SpA) among whites. METHODS To screen for SpA symptoms, such as inflammatory back pain (IBP), joint swelling, psoriasis, and uveitis, or a specific family history, questionnaires were mailed to 348 blood donors (174 HLA-B27 positive and 174 HLA-B27 negative). From the responding 273 persons (78%; 140 B27 positive, 133 B27 negative), 126 were selected for further evaluation based on the symptoms reported. Of this group, 90 persons agreed to undergo physical examination (71.4%; 46 B27 positive, 44 B27 negative). There was no difference between the B27-positive and -negative groups in terms of age (mean +/- SD 38.4 +/- 10 versus 39.5 +/- 11 years) and sex ratio (67% versus 68% were men). In addition, 58 donors (32 B27 positive, 26 B27 negative) agreed to undergo magnetic resonance imaging (MRI) of the sacroiliac joints. A diagnosis of SpA and ankylosing spondylitis (AS) was made according to the European Spondylarthropathy Study Group criteria and the New York criteria. RESULTS SpA was diagnosed in 20 persons: 19 of 140 B27-positive (13.6%) and 1 of 133 B27-negative (0.7%) subjects (15 male and 5 female). AS was diagnosed in 9 persons (7 male and 2 female; 45%), undifferentiated SpA (USpA) in 7 (5 male and 2 female; 35%), psoriatic arthritis (PsA) in 3 (2 male and 1 female; 15%), and chronic reactive arthritis (ReA; Reiter's syndrome) in 1 (male; 5%). On the basis of a B27 frequency of 9.3% among the population of Berlin (3.47 million persons), the estimated prevalence of SpA was 1.9%, AS was 0.86%, USpA was 0.67%, and PsA was 0.29%. The relative risk of developing SpA in B27-positive subjects was calculated as 20.7 (95% confidence interval 4.6-94.2; P = 0.001). Of 58 persons with IBP, sacroiliitis was detected by MRI in 15 of 32 B27-positive (46.9%) and 1 of 26 B27-negative (3.9%) subjects (P = 0.002). Four of these 16 donors did not fulfill diagnostic criteria for SpA. CONCLUSION With a calculated prevalence of 1.9%, spondylarthropathies are among the most frequent rheumatic diseases in the white population. HLA-B27 positive persons carry a 20-fold increased risk of developing SpA. AS and USpA are the most frequent SpA subtypes. Persons with IBP who are B27 positive have a 50% likelihood of having sacroiliitis.

[1]  J. Braun,et al.  Computed tomography guided corticosteroid injection of the sacroiliac joint in patients with spondyloarthropathy with sacroiliitis: clinical outcome and followup by dynamic magnetic resonance imaging. , 1996, The Journal of rheumatology.

[2]  H. Robinson,et al.  Ankylosing Spondylitis in a Canadian Indian Population* , 1966, Annals of the rheumatic diseases.

[3]  M. Khan,et al.  Diagnostic value of HLA-B27 testing ankylosing spondylitis and Reiter's syndrome. , 1982, Annals of internal medicine.

[4]  J. Gran,et al.  Ankylosing spondylitis: a comparative study of patients in an epidemiological survey, and those admitted to a department of rheumatology. , 1984, The Journal of rheumatology.

[5]  P. Bennett,et al.  Sacroiliitis and ankylosing spondylitis in North American Indians. , 1972, Annals of the rheumatic diseases.

[6]  B. M. Jongh,et al.  Risk of developing ankylosing spondylitis in HLA-B27 positive individuals. , 1986, The Journal of rheumatology.

[7]  T. Kvien,et al.  Reactive arthritis: a favorable 2 year course and outcome, independent of triggering agent and HLA-B27. , 1994, The Journal of rheumatology.

[8]  P. Cheah,et al.  Observer variation in grading sacroiliac radiographs in HLA-B27 positive individuals. , 1983, The Journal of rheumatology.

[9]  K. Cohen,et al.  Increased risk for spondylitis stigmata in apparently healthy HL-AW27 men. , 1976, Annals of internal medicine.

[10]  N. Bellamy,et al.  What do we know about the sacroiliac joint? , 1983, Seminars in arthritis and rheumatism.

[11]  J. Wahlström,et al.  A population genetic study of psoriasis , 1994, Acta dermato-venereologica. Supplementum.

[12]  J. Hansen,et al.  The HLA system in Inupiat and Central Yupik Alaskan Eskimos. , 1986, Human immunology.

[13]  J. Gran,et al.  Prevalence of ankylosing spondylitis in males and females in a young middle-aged population of Tromsø, northern Norway. , 1985, Annals of the rheumatic diseases.

[14]  M. Khan,et al.  HLA-B27 and its subtypes in world populations. , 1995, Current opinion in rheumatology.

[15]  M. Khan,et al.  Immunogenetics of spondyloarthropathies. , 1992, Rheumatic Disease Clinics of North America.

[16]  T. Feltkamp,et al.  B27 positive diseases versus B27 negative diseases. , 1988, Annals of the rheumatic diseases.

[17]  K. Siminovitch,et al.  Investigating the genetic basis for ankylosing spondylitis. Linkage studies with the major histocompatibility complex region. , 1994, Arthritis and rheumatism.

[18]  A. Cats,et al.  Spondylitic disease without radiologic evidence of sacroiliitis in relatives of HLA-B27 positive ankylosing spondylitis patients. , 1985, Arthritis and rheumatism.

[19]  V. Wright,et al.  An objective clinical study of chest expansion. , 1972, Annals of the rheumatic diseases.

[20]  J. Gran,et al.  Spinal ankylosing spondylitis: a variant form of ankylosing spondylitis or a distinct disease entity? , 1985, Annals of the rheumatic diseases.

[21]  A. Cats,et al.  Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. , 1984, Arthritis and rheumatism.

[22]  I. Olivieri,et al.  Late onset undifferentiated seronegative spondyloarthropathy. , 1995, The Journal of rheumatology.

[23]  A. Calin,et al.  Striking prevalence of ankylosing spondylitis in "healthy" w27 positive males and females. , 1975, The New England journal of medicine.

[24]  D K FORD,et al.  Reiter's syndrome , 1981 .

[25]  J. Braun,et al.  The sacroiliac joint in the spondyloarthropathies , 1996, Current opinion in rheumatology.

[26]  P. Toivanen,et al.  Bacterial antibodies in HLA-B27+ healthy individuals. , 1993, Arthritis and rheumatism.

[27]  E. Collantes-Estévez,et al.  Assessment of 2 systems of spondyloarthropathy diagnostic and classification criteria (Amor and ESSG) by a Spanish multicenter study. European Spondyloarthropathy Study Group. , 1995, The Journal of rheumatology.

[28]  A. Silman,et al.  Historical background and epidemiology , 1994 .

[29]  J. Gran,et al.  HLA-B27 and spondyloarthropathy: value for early diagnosis? , 1995, Journal of medical genetics.

[30]  M. Dougados,et al.  The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. , 1991, Arthritis and rheumatism.

[31]  M. Dougados,et al.  Are classification criteria for spondylarthropathy useful as diagnostic criteria? , 1995, Revue du rhumatisme.

[32]  D. Brewerton,et al.  Reiter's disease and HL-A 27. , 1973, Lancet.

[33]  A. Calin,et al.  Clinical history as a screening test for ankylosing spondylitis. , 1977, JAMA.

[34]  K. Wolf,et al.  Early sacroiliitis in patients with spondyloarthropathy: evaluation with dynamic gadolinium-enhanced MR imaging. , 1995, Radiology.

[35]  G. Boyer,et al.  Evaluation of the European Spondylarthropathy Study Group preliminary classification criteria in Alaskan Eskimo populations. , 1993, Arthritis and rheumatism.

[36]  J. Dubost,et al.  Late onset peripheral spondyloarthropathy. , 1989, The Journal of rheumatology.

[37]  R. Burgos-Vargas,et al.  The early clinical recognition of juvenile-onset ankylosing spondylitis and its differentiation from juvenile rheumatoid arthritis. , 1995, Arthritis and rheumatism.

[38]  M. Underwood,et al.  Inflammatory back pain in primary care. , 1995, British journal of rheumatology.

[39]  Russell As,et al.  The risk of sacroiliitis in B27 positive persons: a reappraisal. , 1984 .

[40]  G S Alarcón,et al.  Epidemiology of rheumatoid arthritis. , 1995, Rheumatic diseases clinics of North America.

[41]  J. Sieper,et al.  Use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondylarthropathy patients. , 1994, Arthritis and rheumatism.

[42]  H. Zeidler,et al.  Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup. , 1988, The Journal of rheumatology.

[43]  L. Alexeeva,et al.  Prevalence of spondyloarthropathies and HLA-B27 in the native population of Chukotka, Russia. , 1994, The Journal of rheumatology.

[44]  J. Gran,et al.  The prevalence of HLA-B27 in Northern Norway. , 1984, Scandinavian journal of rheumatology.

[45]  J. Gran,et al.  Epidemiology of ankylosing spondylitis. , 2008 .

[46]  C. Cooper,et al.  Ankylosing spondylitis in Rochester, Minnesota, 1935-1989. Is the epidemiology changing? , 1992, Arthritis and rheumatism.

[47]  J. Rubenstein,et al.  The natural disease course of ankylosing spondylitis. , 1983, Arthritis and rheumatism.

[48]  R. Lawrence,et al.  Prevalence of spondyloarthropathies in Alaskan Eskimos. , 1994, The Journal of rheumatology.

[49]  C. Salvarani,et al.  Prevalence of psoriatic arthritis in Italian psoriatic patients. , 1995, The Journal of rheumatology.

[50]  J. Braun,et al.  Pathogenesis of spondylarthropathies , 1995 .

[51]  S. M. van der Linden,et al.  The risk of ankylosing spondylitis in HLA-B27 positive individuals: a reappraisal. , 1984, The Journal of rheumatology.

[52]  M. Dougados,et al.  Predictive factors for the longterm outcome of spondyloarthropathies. , 1994, The Journal of rheumatology.

[53]  R D Sturrock,et al.  Ankylosing spondylitis and HL-A 27. , 1973, Lancet.