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Dr Brown and his colleagues1 are to be congratulated for performing a logistically formidable, but necessary, epidemiological study testing the currently in vogue hypothesis that the B*2703 subtype of HLA-B27 is not related to ankylosing spondylitis (AS). They conclude that the B*2705 subtype, as well as B*2703, possesses a lower risk for developing AS in a group of B27 positive west Africans, the Fula from Gambia, when compared with B27 positive white subjects invoking the potential protective role of an environmental factor(s). This conclusion is based on an assumed risk of developing AS in B27 positive persons of 11.1% for men and 1.5% for women.2 No cases of AS were seen among 900 adult Fula men and 215 first degree relatives of 48 B27 positive Fula twin pairs. We would argue that the data warrant the more conservative conclusion implied in their discussion, namely, the risk for AS among B27 positive Fula subjects would need to be at least 2.7% in men and 1% in women to assign significance to the finding of no AS in this population.
The risk of developing AS in HLA-B27 positive subjects clearly varies among different ethnic groups, but it is now generally accepted that among white populations, the prevalence …