Læknablaðið : fylgirit - 01.05.1978, Page 115

Aima-Liisa Makela and Anja Tiilikainen
Department of Paediatrics, Turku University
Hospital, Turku, and Finnish Red Cross Blood
Transfusion Service, Helsinki, Finland.
The possible association between certain HLA-
antigens and juvenile rheumatoid arthritis has
stimulated several authors to study the tissue
types of their own series of patients with JRA.
The antigen HLA-B27, in particular, has gained
clinical significance leading to a reclassification
of the heterogenous group of patients under the
name of juvenile rheumatoid arthritis. The
disease is proposed to be subclassified into
B-27-JRA and non -B 27 - JRA.
As we know, rheumatoid arthritis and ankylosing
spondyiitis can express themselves similarly in
young chiidren.
Rheumatic disease in the group with the antigen
B27 may subsequently result in ankylosing spondy-
litis.
In our series of 104 children with JRA 34% had
the antigen HLA-B27, two of whom were homo-
zygous. In three chiidren with HLA-B27, one of
the parents had ankylosing spondylitis and had
the antigen B27,-^oo.
B-27 was more common in the oligoarticular
forms of JRA (Table 1) being found in 44% of the
oligoarticular cases in girls and in 4C% in boys.
It is very iikely, that among the 18 patients with
oligoarthritis and the antigen B27, there are
cases, who probably later will progress to
ankylosing spondylitis.
On the other hand, sacroiliac changes were
found in four children, three of whom had the
antigen B27.
HLA ANTIGENS IN CHILDREN
WITH JUVENILE
RHEUMATOID ARTHRITIS
Curiously enough, the only patient without the
antigen B27 was the one, showing the most
striking changes of the sacroiliac joints with
erosions and sclerosis. This patient had also
rheumatic iridocyclitis and a slightly positive
Waaler-Rose reaction (1:128).
The incidence of B27 was not found to be
elevated in our patients with rheumatic iridocye-
litis. In 19 children with iridocyclitis only six
(187o) had the antigen B27. Nine of these patients
(47%) had the antigen BW 15, which is a higher
percentage than in the whole series (33%).
The antigen B27 had no association with anti-
nuclear antibodies.
The results of the tissue typing of our series
are seen in Table 2. HLA-antigens are identified
by the NIH (National Institute of Health) standard
techniques in the Finnish Red Cross Blood Trans-
fusion Service, Helsinki.
In addition to the antigen B27, the antigens
B8, BW15 and BW40 are of particular interest:
B8 because of its reported association to Sjögrens
syndrome, BW15 because of its association to
certain cases of SLE, and BW40 because of its
association to adult rheumatoid arthritis.
Table 3 shows the frequency of these antigens
in our material and in normal controls. The
frequency of B27 is clearly increased in patients
with juvenile rheumatoid arthritis. A slight in-
crease is also observed in the frequeney of the
antigens BW15 and BW40.
TABLE 1. FREQUENCY OF HLA-B 27 ANTIGEN IN 104 PATIENTS UHDER
THE DIAGNOSE JUVENILE RHEUMATOID ARTHRITIS.
OLIGOARTHRITIS POLYARTHRITIS STILL-TYPE
Male Female Male Female Male Female
6/15 12/27 2/11 12/40 1/3 2/8
40% 44% 18% 30% 33% 25%
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