Introduction/Objectives Psoriatic 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. Method We 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. Results HLA-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. Conclusions HLA-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. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec colname="c1" colnum="1" /> <colspec colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> 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 </entry> </row> </tbody> </tgroup> </Table>

Exploring the phenotypic expression of HLA-B27 in psoriatic arthritis

期刊论文
发表日期：

2026年4月25日

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Cristina Macia-Villa,
Jose Ignacio Fernandez-Velasco,
Mauro Ferre-Sanfrancisco,
Daniel Albert Mendoza-Bravo,
Ana Maria Ruiz-Bejerano,
Celia Ferrez-Hernandez,
Jose Luis Morell-Hita

摘要

Introduction/Objectives

Psoriatic 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.

Method

We 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.

Results

HLA-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.

Conclusions

HLA-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