From the Guidelines
A negative HLA-B27 test result does not rule out spondyloarthritis, and diagnosis should not be based solely on this laboratory result. According to the guidelines released by NICE, as reported in the American Family Physician in 2017 1, a negative HLA-B27 test result should not be used to exclude spondyloarthritis. This is because some patients without the HLA-B27 marker can still develop the condition.
Key Points to Consider
- A negative HLA-B27 test result is not a definitive indicator of the absence of spondyloarthritis
- Diagnosis of spondyloarthritis should be based on a combination of clinical symptoms, imaging studies, and laboratory tests, including but not limited to HLA-B27 testing 1
- Patients with symptoms such as chronic back pain, joint inflammation, or other rheumatic symptoms should undergo a comprehensive evaluation by a healthcare provider, regardless of their HLA-B27 status
- The management of axial spondyloarthritis involves referral to a subspecialist for a structured exercise program and first-line pharmacologic treatment with the lowest effective dose of a nonsteroidal anti-inflammatory drug, with continued evaluation and monitoring 1
Implications for Clinical Practice
- Healthcare providers should not rely solely on HLA-B27 test results to diagnose or rule out spondyloarthritis
- A comprehensive diagnostic approach is essential to accurately diagnose and manage spondyloarthritis, even in patients with a negative HLA-B27 test result
- Patients with a negative HLA-B27 test result who are experiencing symptoms consistent with spondyloarthritis should still be evaluated and managed accordingly, with consideration of other diagnostic tools and treatments as needed 1
From the Research
Significance of a Negative HLA-B27 Test Result
- A negative HLA-B27 test result does not necessarily rule out the presence of spondyloarthritis, as the disease can occur in HLA-B27 negative individuals 2, 3, 4.
- Studies have shown that HLA-B27 negative patients with axial spondyloarthritis may have higher disease activity and poorer treatment outcomes compared to HLA-B27 positive patients 3, 4.
- The absence of HLA-B27 may be associated with an increased probability of starting the disease with cervical pain and peripheral manifestations in ankylosing spondylitis patients, and with the onset of arthritis and psoriasis in psoriatic arthritis patients 2.
- HLA-B27 negativity has been linked to poorer treatment adherence and lower response rates to tumor necrosis factor inhibitor (TNFi) treatment in patients with nonradiographic axial spondyloarthritis and ankylosing spondylitis 4.
- The role of HLA-B27 in the pathogenesis of axial spondyloarthritis is still unclear, but it is thought to play a major role in the presentation of arthritogenic peptides to the immune system 5, 6.
Implications of a Negative HLA-B27 Test Result
- A negative HLA-B27 test result may lead to a delay in diagnosis and treatment of spondyloarthritis, as clinicians may be less likely to consider the disease in HLA-B27 negative patients 3.
- HLA-B27 negative patients may require more aggressive treatment and closer monitoring to achieve optimal outcomes 4.
- Further research is needed to fully understand the significance of a negative HLA-B27 test result and its implications for the diagnosis and treatment of spondyloarthritis 2, 5, 6.