Objectives This retrospective study was designed in order to evaluate the relationship between disease severity and HLA-B27 at time of diagnosis in ankylosing spondylitis (AS).
Methods Medical records of patients admitted to the outpatient clinic of Uludag University Medical Faculty, Department of Physical Medicine and Rehabilitation since 1988, who were diagnosed to have AS according to the 1966 New York Criteria were retrospectively reviewed. Forty-four patients were first diagnosed and had HLA-B27 evaluation. Further analysis was performed for this group which constituted the study population including sex, age at onset, disease duration until admission, HLA-B27 status, family history of AS, rheumatic symptoms, morning stiffness duration, presence of arthritis, sacroiliac tests, ESR (mm/hr), CRP (mg/dl), radiographic grade of sacroiliitis, and lumbar flexibility (assessed by Schober?s test), lumbar lateral flexion limitation, finger-to-floor distance, occiput-wall distance, chin-to-manibrium distance, chest expansion.
Results Out of the study population (11 female, 33 male; n = 44) with a mean age of 34.5 ± 10.2 years, 35 patients (79.5%) were HLA-B27 (+). Mean age of disease onset was 30.0 ± 9.9 years, and mean time of disease duration until diagnosis was 55.6 ± 47.5 months. Eight patients (13.8%) had a positive family history, 9 (20.5%) had heelpain, 5 (11.4%) had chestpain, 42 (95.5%) had backpain, and 3 (6.8%) had systemic involvement at admission. Radiographic sacroiliitis was found as Grade:2 in 15 patients, Grade:3 in 16 patients, and Grade 4 in 13 patients.
Disease duration until admission was significantly less in HLA-B27 (+) patients compared to B27(-) ones (p = 0.027). Duration of morning stiffness was significantly higher (p = 0.050), and significantly more B27(+) patients had positive sacroiliac tests (p = 0.048). However, physical parameters such as lumbar lateral flexion and chest expansion was significantly better (p = 0.003 and 0.018, respectively) in B27 (+) patients. No significant difference was observed in other clinical and physical parameters.
Conclusion Our results suggest that B-27(+) AS patients tend to admit earlier with more severe clinical symptoms and signs before the development of physical limitations.
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