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Higher mortality, rate of SpA observed in HLA-B27+ veterans
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Veterans who carried the HLA-B27 gene had higher risk for early mortality and a higher risk for ankylosing spondylitis and other diseases, according to recently published research. However, certain diseases were less common in HLA-B27-positive veterans.
Researchers identified 32,630 anonymized veterans from the Veterans Health Administration Corporate Data Warehouse and Vital Status File who had been tested for the presence of the HLA-B27 gene between Oct. 1, 1999, and Dec. 31, 2011. Participants were excluded if test results were unclear or if birth and death dates were not available. Other exclusion criteria included prior diagnosis of systemic inflammatory diseases and diseases that mimic spondyloarthritis (SpA).
Veterans in the study were followed until death or last study date. Mean follow-up time after testing was between 4.6 and 4.8 years. Variables in the Cox proportional hazards models included age at study entry, sex, race, development of psoriasis, inflammatory bowel disease, other inflammatory arthritis, exposure to biologic and conventional disease-modifying anti-rheumatic drugs (DMARDs), and comorbidities, including those suspected to trigger HLA-B27 expression and those that were not.
Of the cohort, 4,978 (15.3%) tested positive for the gene. Male sex was identified in 92.9% of veterans who carried the gene and in 88.4% of those who did not.
SpA was more common (34.8%) in the HLA-B27-positive group compared with those who were negative for the gene (8.7%), according to the researchers.
After adjusting for age, sex, race, diseases suspected to influence testing for HLA-B27 and SpA, higher mortality was seen in veterans with the gene. In the subgroup without SpA, the adjusted HR was 1.11 compared with 1.35 in patients with SpA. The hazard ratio was 1.15 for both groups when further adjusted for treatment with biologic and nonbiologic DMARDs, according to the researchers.
Several comorbidities not associated with HLA-B27 were more common in the positive group, including diabetes, injury or trauma, lipid disorders, mood or anxiety disorders and pulmonary disease. Uveitis was also more common in the group that tested positive for the gene.
Conversely, other types of inflammatory arthritis were less common in those who tested positive for HLA-B27 (2.4% vs. 11.4%, respectively), according to the researchers. – by Shirley Pulawski
Disclosures: The authors report no relevant financial disclosures.
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