ArticleClinical rheumatology2026
Exploring the phenotypic expression of HLA-B27 in psoriatic arthritis.
Article in Clinical rheumatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
INTRODUCTION/
objectivesPsoriatic arthritis (PsA) is a heterogeneous inflammatory disease within the spectrum of spondyloarthritis (SpA) that shares genetic and clinical features with other subtypes. HLA-B27 is a well-established genetic risk allele for axial SpA, while its role in PsA is less clear. This study aimed to investigate the association between HLA-B27 and the clinical, laboratory, and therapeutic features of a real-world PsA cohort.
methodWe performed a retrospective analysis of 333 patients with PsA who fulfilled the CASPAR criteria and had documented HLA-B27 status. Demographic, clinical, laboratory, and treatment-related data were extracted from medical records. Patients were compared based on HLA-B27 positivity using appropriate statistical analyses. Statistical significance was set at p < 0.05.
resultsHLA-B27 was positive in 11.7% of patients. Compared with HLA-B27-negative individuals, HLA-B27-positive patients showed significantly earlier PsA onset (42.8 vs. 49.1 years, p = 0.003), more frequent axial involvement (46.2% vs. 24.5%, p = 0.004), and higher prevalence of enthesitis (33.3% vs. 18.4%, p = 0.028). CRP levels were also higher in HLA-B27-positive patients (median 5.5 vs. 3.2 mg/L, p = 0.015). No significant differences were observed in sex, dactylitis, uveitis, treatment response, comorbidities, or frequency of difficult-to-treat and treatment-refractory disease between the two groups. Interestingly, HLA-B27 negativity was associated with higher FIB-4 scores (p = 0.034), a marker of hepatic fibrosis.
conclusionsHLA-B27 is associated with a distinct clinical phenotype in PsA, including earlier onset, axial disease, enthesitis, and elevated systemic inflammation. These findings highlight the relevance of HLA-B27 in PsA stratification and support its role in identifying disease profiles. Key Points • HLA-B27 positivity was associated with an earlier PsA onset, axial involvement, and enthesitis. • Elevated CRP levels in HLA-B27-positive patients suggest increased systemic inflammation in this profile. • HLA-B27 status did not significantly affect the treatment response, comorbidities, or frequency of difficult-to-manage/refractory PsA. • HLA-B27 may help in the clinical stratification of PsA patients.
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