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HLA B27 in rheumatoid factor-negative polyarthritis

J M Esdaile, I L Dwosh, M B Urowitz

Annals of Internal Medicine

|June 1, 1977

Summary

The B27 test did not improve diagnosis for rheumatoid factor-negative polyarthritis patients. Clinical evaluation effectively distinguished spondylitic variants from rheumatoid arthritis, regardless of B27 status.

Area of Science:

Rheumatology
Immunogenetics
Clinical Diagnostics

Background:

Rheumatoid factor-negative polyarthritis presents diagnostic challenges.
The role of the B27 antigen in seronegative arthropathies requires clarification.

Purpose of the Study:

To evaluate the diagnostic utility of the B27 test in rheumatoid factor-negative polyarthritis.
To compare clinical diagnosis with B27 testing in differentiating arthritic syndromes.

Main Methods:

Prospective evaluation of 83 consecutive patients with rheumatoid factor-negative polyarthritis.
Clinical assessment, radiological imaging, and HLA-B27 testing were performed.
Exclusion criteria included definite spondylitis, juvenile chronic polyarthritis, collagen diseases, metabolic arthropathies, and osteoarthritis.

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Main Results:

Two distinct patient groups emerged: 25 with spondylitic variant syndromes (male preponderance, high B27 positivity) and 58 with rheumatoid arthritis (female preponderance, normal B27 prevalence).
Clinical diagnosis independently classified patients into these two groups.
The B27 test did not offer additional diagnostic value beyond clinical assessment for spondylitic variants.
The B27 test did not identify a distinct subgroup within the rheumatoid arthritis group.

Conclusions:

Clinical evaluation is sufficient for diagnosing spondylitic variant syndromes in rheumatoid factor-negative polyarthritis.
The B27 test provides limited additional benefit in differentiating these seronegative arthropathies.
Diagnostic strategies for rheumatoid factor-negative polyarthritis can rely primarily on clinical and radiological findings.