What is the role of HLA-B27 testing in the workup of reactive arthritis (ReA)?

Updated: Dec 24, 2020
  • Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

The presence of human leukocyte antigen (HLA)-B27 correlates with axial disease, carditis, and uveitis. HLA-B27 test results are positive in 65%-96% of ReA cases (67-92% of pediatric cases). HLA-B27 testing is not diagnostic of ReA and thus not required; however, it may be helpful for certain purposes (eg, supporting the diagnosis of ReA in patients with joint-restricted symptoms). The HLA-B27 test is moderately expensive and should not be ordered indiscriminately as a screen.

In a report by Shimamoto et al, a Japanese man with ReA was negative for HLA-B27 and other HLA-B27 cross-reactive major histocompatibility complex (MHC) class I antigens but was positive for HLA-B51. [85] Laboratory examination showed significant elevation of serum levels of IgA and IgG antichlamydial antibodies. The authors suggested that a combination of Chlamydia infection and HLA-B51 presence might play a role in the pathogenesis of ReA in this patient.


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