HLA-B27 Testing in Practice Save

A single center study shows HLA-B27 testing is often performed by both by rheumatologists and nonrheumatologists for a wide array of reasons and often along with other serologic tests.  Optimal use of HLA-B27 testing has yet to be defined. 

HLA-B27 is strongly associated with spondyloarthritis (SpA) and uveitis and is part of the classification criteria and referral strategies for axial spondyloarthritis (SpA). 

Analysis of adults tested for HLA-B27 at the Mass General Brigham healthcare system looked at ordinger, co-ordering and clinical implications. 

HLA-B27 tests were ordered for 1960 patients, most commonly by rheumatology (40%) and ophthalmology (21%). Overall, 11% were HLA-B27 positive. Ophthalmology had the highest positive rate (15%), whereas reactive arthritis was the indication with the highest positive test rate (50%). 

The most common indications for HLA-B27 testing were:

• Peripheral arthritis (33%)

• Uveitis (22%) 

• Back pain (16.7%)

Nearly 70% of HLA-B27 tests (69.3%) were ordered concurrently with other autoantibody tests. 

Patients who were HLA-B27 positive were more likely to be referred to rheumatology (53% vs 32%; P = 0.002). 

Judicious use of HLA-B27 testing hinges on its added value in uncertain but suggestive clinical scenarios (eg, low back pain, suspected uveitis or reactive arthritis) and avoidance of HLA-B27 testing as a "screening" test in low risk populations.