Introduction

This campaign provides information on the use of HLA-B27 in diagnosing Spondyloarthritis (SpA).

Practice Points

• Ankylosing Spondylitis (SpA) is a progressive inflammatory rheumatologic disease, which can be ameliorated by medical interventions.
• In patients with ≥3 months of back pain and age of onset <45 years SpA is a potential diagnosis.
• This diagnosis may be made by finding: sacroiliitis on MRI or HLA- B27 with at least two features of SpA.
• An inexpensive HLA-B27 test has been developed locally (tagSPN).
• HLA-B27 test utilization over 33 months at Eastern Health is presented.

Choosing Wisely Canada guidelines: don’t order an HLA-B27 unless SpA is suspected based on specific signs or symptoms.

Our Data

The Use of HLA-B27 by Doctor

From the graph below, we can see that over 33 months, from Jan 1 2015-Oct 1 2017, 1108 tests were ordered by 280 doctors.

This indicates that the majority of the tests were ordered by only a small number of doctors.

HLA-B27 should be ordered in patients with ≥3 months of back pain and age of onset of symptoms <45 years when SpA is suspected.

51% of tests were ordered in patients ≥45 years. However it is unknown the age of onset of symptoms.

What You Can Do

Order HLA-B27 (tagSNP) if SpA is suspected based on the presence of low back pain for ≥ 3 months with onset <45 years, and specific signs or symptoms consistent with SpA.