Lower HLA-B27 positivity and heterogeneous late-onset case proportions across axial spondyloarthritis cohorts: a systematic review and meta-analysis.

What was studied

This review looked at late-onset axial spondyloarthritis, including ankylosing spondylitis. Late onset was defined as symptoms starting at age 45 or older. The aim was to find how many cases are late-onset. It also compared later- and earlier-onset forms. The team searched databases through 20 August 2026. It included reports from 42 independent studies. Risk of bias and certainty were rated.

What they found

745 late-onset cases were found among 6,631 patients with known onset age. The pooled share had a very wide range, and results differed a lot between studies. Certainty was very low. HLA-B27 positivity was lower with later onset. The odds ratio was 0.47, from 4 studies with 2,593 people. Male sex, X-ray sacroiliitis and BASDAI scores were inconclusive. Other kinds of phenotypes were not pooled.

What it means for patients

The authors say late-onset shares varied a lot and certainty was very low. They say lower HLA-B27 positivity was the most consistent link. They say it cannot be read as a cause. They also say it cannot be used to diagnose.

Why it is not certain yet

The HLA-B27 link relied on a few unadjusted comparisons. Heterogeneity was high. The prediction interval was wide. Some phenotypes were too different to pool. A review can only be as good as the studies in it.

Source

Lower HLA-B27 positivity and heterogeneous late-onset case proportions across axial spondyloarthritis cohorts: a systematic review and meta-analysis.

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