Clinical and immunological characteristics of patients with spondyloarthritis

2019 Fiscal Year Final Research Report

• Project/Area Number: 16K09906
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Collagenous pathology/Allergology
• Research Institution: Keio University
• Principal Investigator: KANEKO Yuko 慶應義塾大学, 医学部(信濃町), 准教授 (60317112)
• Project Period (FY): 2016-04-01 – 2020-03-31
• Keywords: 脊椎関節炎 / HLA

Outline of Final Research Achievements

We collected questionnaires from 275 patients with inflammatory bowel syndrome or with psoriasis. Inflammatory back pain, which is a characteristic symptom for axial SpA, were reported in 33.7%, and 5 patients were newly diagnosed with SpA suggesting that there can be patients with undiagnosed SpA in 1.8% and those with suspected SpA in 18.0%. A questionnaire to ask the presence of awakening at midnight could efficiently discriminate patients with newly diagnosed SpA and those without. Comprehensive measurement of HLA-A, -B, and -DR serotypes, the positivity of HLA-B27 was 2.8%, which was quite low compared to 50-90% in Western countries. Alternatively, HLA-B46 was detected significantly more frequently in the patients with Japanese SpA than in the general population (27.8% vs. 9.3%; p = 0.0013), suggesting HLA-B46 was a unique HLA serotype in Japanese patients with SpA.

Free Research Field

リウマチ・膠原病

Academic Significance and Societal Importance of the Research Achievements

脊椎関節炎は、全身性の腱付着部炎と二次性関節滑膜炎を特徴とする自己炎症性疾患で、
全身性多臓器障害をきたす。疾患感受性遺伝子としてHLA B27が全世界的に知られているが，日本人では保有率が低く診断が困難であった．近年，炎症性サイトカインを標的とする生物学的製剤で有効かつ安全に治療可能となったことから、早期診断早期治療の重要性が増している．本研究で、隠れ脊椎関節炎患者が2%弱、疑いは20%弱存在することを示し、鑑別診断として上位に位置づけた意義は大きい。また、早期診断に対し、世界的に有用とされるHLA-B27は日本人では検出されにくいが、HLA-B46がマーカーとなりうることを示し有意義である。