HLA B27

The Test
1. 2. 3. 4. How is it used? When is it ordered? What does the test result mean? Is there anything else I should know?

How is it used?
The HLA-B27 test is primarily ordered to help strengthen or confirm a suspected diagnosis of ankylosing spondylitis (AS), reactive arthritis, juvenile rheumatoid arthritis (JRA), or sometimes anterior uveitis. The HLA-B27 test is not a definitive test that can be used to diagnose or rule out a disorder. It is used as one piece of evidence in a constellation of signs, symptoms, and lab tests to support or rule out the diagnosis of certain autoimmune disorders, such as AS and reactive arthritis. AS and reactive arthritis are both chronic, progressive conditions that occur more frequently in men than women. The first symptoms typically occur when a person is in their early 30's. Often, the initial symptoms of these autoimmune disorders are subtle and may take several years before characteristic degenerative changes to bones and joints are visible on X-rays.

Ankylosing spondylitis is characterized by pain, inflammation, and a gradual stiffening of the spine, neck and chest. Reactive arthritis is a group of symptoms that includes inflammation of the joints, urethra, eyes, and skin lesions. Juvenile rheumatoid arthritis is a form of arthritis that occurs in children. Anterior uveitis is associated with recurring inflammation of the structures of one or both eyes.

The HLA-B27 test may be ordered as part of a group of tests used to diagnose and evaluate conditions causing arthritis-like chronic joint pain, stiffness, and inflammation. This group of tests may include an RF (rheumatoid factor) with either an ESR (erythrocyte sedimentation rate) or a CRP (C-Reactive protein). HLA-B27 is sometimes ordered to help evaluate someone with recurrent uveitis that is not caused by a recognizable disease process. ^ Back to top

When is it ordered?
An HLA-B27 test may be ordered when a person has acute or chronic pain and inflammation in the spine, neck, chest, eyes, and/or joints, and the doctor suspects an autoimmune disorder that is associated with the presence of HLA-B27. Doctors frequently must rely on their clinical findings

and the HLA-B27 test result when diagnosing ankylosing spondylitis, and other HLA-B27related disorders, because the characteristic changes to the bones may not be detectable for several years. Under these circumstances, HLA-B27 is not diagnostic but adds additional information, increasing or decreasing the likelihood that the patient has ankylosing spondylitis. An HLA-B27 may also be ordered when someone has recurrent uveitis. ^ Back to top

What does the test result mean?

If a person is positive for HLA-B27 and has symptoms such as chronic pain, inflammation, and/ or degenerative changes to his bones (as seen on X-ray), then it supports a diagnosis of ankylosing spondylitis, reactive arthritis, or another autoimmune disorder that is associated with the presence of HLA-B27. This is especially true if the person is young, male, and if he experienced his first symptoms before the age of 40. If HLA-B27 is negative, then the association is not there. This does not, however, mean that the person does not have the suspected condition, as a certain percentage of people with each disorder will be HLA-B27 negative.

Ankylosing spondylitis: about 90% are HLA-B27 positive Juvenile rheumatoid arthritis (JRA): about 80% are HLA-B27 positive Reactive arthritis: about 60-85% are HLA-B27 positive Isolated acute anterior uveitis: about 40-70% are HLA-B27 positive

Whether or not HLA antigens will be present is genetically determined. Their production is controlled by genes that are passed from parents to children. If a person has a close family member with an HLA-B27 related disease that affects the joints of the spine (AS or other related condition) and is positive for the HLA-B27 antigen, then that person is at an increased risk of developing a similar disease. ^ Back to top

Is there anything else I should know?

Though the diseases associated with HLA-B27 occur more frequently in men, women can also be affected. However, the signs and symptoms related to the diseases can often be milder in women. With new genetic testing methods, it is now possible to separate HLA-B27 into subtypes. So far, about fifteen different subtypes have been identified. The most common in the U.S. are HLA B27*05 and HLA B27*02. How the presence of these specific subtypes affects the likelihood of developing an autoimmune disease is not yet known.

Auto-immune disease HLA-B27, client pain free on no starch, paleo diet

Posted on February 12, 2011 by Julianne

In August 2010 I met Tab, an energetic 28 year old, through CrossFit Auckland where I work as a nutrition coach. Tab had a goal to lose weight. As we went through her medical issues Tab told me she had an auto-immune disease, non specific, but linked with the HLA-B27 gene. As a result she suffered back pain which was at times debilitating, and she swallowed voltarin to keep it at bay. It was always present and she could no longer run without a lot of discomfort. Another symptom of this auto-immune disease for Tab was iritis which flared up every few months, also eczema. She also said that she had problems with some foods that caused IBS symptoms; sugar, corn, dairy and mushrooms had been identified as causing problems for her. When anyway even breathes the word auto-immune disease, my first response is a strict paleo diet, and possibly removing eggs and nightshades as well. Loren Cordain has written extensively about the connection of agricultural foods triggering auto-immune disease. I suggested Tab trial a strict Paleo diet. But what about this specific gene HLA-B27? Ive seen clients with this before. HLA-B27 is strongly associated with ankylosing spondylitis (AS). 95% of people with AS have this gene, although only a small percentage of people (10 20%) with HLA-B27 develop AS. It is also associated reactive arthritis (Reiters Syndrome), inflammatory eyes disorders, uveitis and iritis, psoriatic arthritis and ulcerative colitis and irritable bowel syndrome (IBS). There are several theories as to why people with this gene develop auto-immune diseases. With respect to AS sufferers, they also have HLA-B27 gene plus IBS, suggesting a gut problem may contribute. (Although Tab has never had a positive diagnosis of AS, she had relatives with it, and her back pain suggested it). As only a small percent of people with the gene develop AS, this suggests an environmental trigger. (As Matt Ridley says in Nature via Nurture says Nature loads the gun, environment pulls the trigger) Dr Alan Ebringer, at Middlesex Hospital, London noticed this link and began researching a possible trigger, which he thought might be a microbe. The hypothesis was that a certain percentage of people were infected by a microbe that possessed molecules resembling the blood group HLA-B27, when a person becomes infected by this microbe, and develops anti-bodies against it, these same anti-bodies attacked their own similar tissue. After testing different microbes in rabbits (injected with HLA-B27 lymphocytes) a bowel microbe called Klebsiella was identified. Klebsiella appeared to have molecules that resembled the HLA-B27 blood group and also the collagens found in the spine and large joints. Klebsiella microbes are a normal component of human bowel flora, but AS patients tested were found to have greater amounts in their stools. Elevated levels of antibodies to Klebsiella were found in AS patients, especially during the active phase of the disease, i.e during flare-ups. Further studies in other countries also found elevated anti-bodies to klebsiella in AS patients. The next problem was getting rid of the klebsiella. Antibiotics will kill it, however reinfection is likely. The answer

came, like many discoveries, by accident. One of Ebringers patients wanted to lose weight, and asked for a diet plan that would work. He devised an unconventional plan. As much steak and tomatoes as you can eat, plus a bottle of red wine a day! When he next saw the doctor he remarked Not only have I lost weight, but my joint and back pains have disappeared! The penny dropped for Ebringer, the diet lacked starch, the klebsiella must be living in the gut feeding on undigested starch. Tests on patients confirmed this, and he found several nutrition studies that demonstrated bacterial growth in the colon is fed by dietary starch. Ebringer tested a no starch diet on hundreds of AS patients at the Middlesex Hospital in London. These patients continued their medication, however he found he could achieve therapeutic effects with much lower levels of drugs. The low starch diet was found to be particularly effective for those with early stages of the disease, before irreversible spine and joint damage. It is also pertinent to note that he found not all AS patients respond to a no starch diet, but it is worth trying as it usually makes a difference. Carol Sinclair, who suffers IBS, back and other joint pain, wrote a very accessible book on her own search to find a cure for what seemed like multiple health problems. Subsequent tests showed she had the HLA-B27 gene which led her to the research by Dr Ebringer. She experimented with a starch free diet, and found her IBS resolved and her pain disappeared. Id read this book some years ago and when Tab told me of her medical problems, which mirrored Carol Sinclairs, it seemed to me that she might benefit from a starch free diet, in addition to an anti-autoimmune paleo diet, and I suggested she read Carols book. She immediately read both The IBS Low Starch Diet and The Paleo Diet, and altered her diet. The Paleo diet cuts out all gut irritating foods, that cause leaky gut. A leaky gut allows fragments of bacteria and other partially digested proteins to get through to the bloodstream, and if these are similar to our own tissues, like the klebsiella bacteria, an auto-immune reaction is set up. So in theory, a dietary approach that allows the gut to heal, and also decreases the food source to the offending bacteria, should reduce the auto-immune reaction. Here is Tabs own story: My name it Tab and I started Paleo eating at the end of August when I meet Julianne through CrossFit, I was tired of being overweight and needed to get a handle on my fitness before returning to work. I am 510 weighed in at 98.8kgs on August 21st, I now weigh 88.3kgs, and Im at least a dress size smaller. (15 December 2010) I have an Auto-immune disease not specifically diagnosed, however Im HLA-B27 positive and I get iritis in alternative eyes when Im stressed, and my back constantly gave me pain causing me to chew through pain killers. Ive always been told that there was no cure and that all we can do is manage the pain. Julianne put me onto the IBS diet book which had some interesting information about being HLA-B27 positive, I felt like the book was written about me. The book suggested that starch could cause these problems, through leaky gut and my body attacking itself. So I decided to remove all starch from my diet. And wow would you know it my pain reduced within 3 days. At first it was difficult to remove bread and rice and pasta and other starches from my diet as I felt like I was missing out, but with advice and encouragement from my Husband and Julianne I have managed it. In November I was still getting some pain, and I discovered quite by accident

that the Vitamins* I was taking were also adding to my pain, as once they ran out my pain completely disappeared, returning occasionally. I still occasionally struggle to maintain Paleo eating and have occasional moments where I think Ill be okay and eat some potato or something only to discover that my pain is back, however Im still slowly losing weight, pain free and enjoying experimenting with natural foods. Another result was that my eczema cleared up. *The Vitamins were Usana Essential Multivitamin and Mineral tablets. Here is a list of the Other Ingredients contained in the supplement. MICROCRYSTALLINE CELLULOSE, PREGELATINIZED STARCH, CROSCARMELLOSE SODIUM, COLLOIDAL SILICON DIOXIDE, ASCORBYL PALMITATE, DEXTRIN, DEXTROSE.