Affordable HLA-B27 Detection in Resource-Limited Settings: Evaluating Conventional PCR for Uveitis and Spondyloarthropathy in Indonesia

Authors

  • Rina La Distia Nora Department of Ophthalmology, Faculty of Medicine Universitas Indonesia- Cipto Mangunkusumo Kirana Eye Hospital
  • Lukman Edwar Department of Ophthalmology, Faculty of Medicine Universitas Indonesia- Cipto Mangunkusumo Kirana Eye Hospital
  • Made Susiyanti Department of Ophthalmology, Faculty of Medicine Universitas Indonesia- Cipto Mangunkusumo Kirana Eye Hospital
  • Yulia Aziza Department of Ophthalmology, Faculty of Medicine Universitas Indonesia- Cipto Mangunkusumo Kirana Eye Hospital
  • Ikhwanuliman Putera Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
  • Ulifna Alfiya Sifyana Department of Ophthalmology, Faculty of Medicine Universitas Indonesia- Cipto Mangunkusumo Kirana Eye Hospital
  • Mei Riasanti Indonesia Infectious Disease and Immunology Research Center (IDIRC), Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, University of Indonesia
  • M Zakiy Waliyuddin Indonesia Infectious Disease and Immunology Research Center (IDIRC), Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, University of Indonesia
  • Maria Valentina Wibawa Department of Ophthalmology, Faculty of Medicine Universitas Indonesia- Cipto Mangunkusumo Kirana Eye Hospital
  • Rachel Ethelind Department of Ophthalmology, Faculty of Medicine Universitas Indonesia- Cipto Mangunkusumo Kirana Eye Hospital
  • Erica Widodo Department of Ophthalmology, Faculty of Medicine Universitas Indonesia- Cipto Mangunkusumo Kirana Eye Hospital
  • Ratna Sitompul Department of Ophthalmology, Faculty of Medicine Universitas Indonesia- Cipto Mangunkusumo Kirana Eye Hospital

DOI:

https://doi.org/10.35749/oi.v52i1.102039

Keywords:

Spondyloarthropathy, Acute Anterior Uveitis, HLA-B27, Conventional PCR, Cost-Effective Diagnostic Methods

Abstract

Introduction: HLA-B27 is a genetic marker strongly associated with spondyloarthropathy (SpA) and acute anterior uveitis (AAU). Detection of this allele can support earlier diagnosis and targeted management. However, commercially available HLA-B27 tests are costly and often inaccessible in low- and middle-income countries, including Indonesia. Methods: A cross-sectional study was conducted involving 42 subjects: 14 with SpA, 19 with AAU, and 9 healthy controls. DNA was extracted from peripheral blood samples and analyzed using both conventional PCR (targeting exon 3 of HLA-B27) and a commercial HLA-B27 strip assay. Sensitivity, specificity, and diagnostic accuracy of conventional PCR were calculated against the commercial kit as the reference standard. Results: Conventional PCR showed high sensitivity (100%) and accuracy (85.71%) in SpA patients, indicating its potential as a reliable screening tool in this group. However, its performance in AAU patients was suboptimal, with lower sensitivity (40%) and specificity (55.56%). False positives and false negatives were observed, likely due to limitations in allele coverage by conventional primers. Conclusion: Conventional PCR is a promising, affordable alternative for HLA-B27 detection in SpA patients, particularly in resource-limited settings. However, its lower reliability in AAU cases highlights the need for careful clinical application and further optimization. Larger studies and local allele mapping are recommended to enhance diagnostic precision in diverse populations.

Downloads

Download data is not yet available.

References

1. Kataria RK, Brent LH. Spondyloarthropathies. Am Fam Physician. 2004;69(12):2853–60.

2. Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet [Internet]. 2017;390(10089):73–84. Available from: http://dx.doi.org/10.1016/S0140-6736(16)31591-4

3. Reveille JD, Immunogenetics C. HHS Public Access. 2015;34(6):1009–18.

4. Walsh JA, Magrey M. Clinical Manifestations and Diagnosis of Axial Spondyloarthritis. 2021;27(8):31–3.

5. Sharma N, Sharma V, Masood T, Nautiyal SC, Sailwal S, Singh RK, et al. Usage of conventional PCR technology for the detection of HLA-B27 allele: A significant molecular marker of ankylosing spondylitis. Indian J Clin Biochem. 2013;28(2):189–92.

6. Sheehan NJ. The ramifications of HLA-B27. Journal of the Royal Society of Medicine. 2004.

7. Standardization T, Sun N, Group W. Classification Criteria for Spondyloarthritis/HLA-B27-Associated Anterior Uveitis. Am J Ophthalmol 2021;228:117–25. Available from: https://doi.org/10.1016/j.ajo.2021.03.049

8. Zhang S, Wang Y, Peng L, Su J, Zeng X. Comparison of Clinical Features in HLA-B27 Positive and Negative Patients With Axial Spondyloarthritis : Results From a Cohort of 4 , 131 Patients. 2020:1–7.

9. Li H, Li Q, Ji C, Gu J, Li H. Ankylosing Spondylitis Patients with HLA-B * 2704 have More Uveitis than Patients with HLA-B * 2705 in a North Chinese Population Ankylosing Spondylitis Patients with HLA-B * 2704 have More Uveitis than Patients with HLA-B * 2705 in a North Chinese Population. Ocul Immunol Inflamm 2018;26(1):65–9. Available from: https://doi.org/10.1080/09273948.2016.1188967

10. Costantino F, Talpin A, Said-Nahal R, Goldberg M, Henny J, Chiocchia G, et al. Prevalence of spondyloarthritis in reference to HLA-B27 in the French population: Results of the GAZEL cohort. Ann Rheum Dis. 2015;74(4):689–93.

11. Mardjuadi, A. (1999). HLA-B27 associated rheumatologic diseases in Indonesia. [Thesis, externally prepared, Universiteit van Amsterdam].

12. Skalska U, Kozakiewicz A, Mäliński W, Jurkowska M. HLA-B27 detection - Comparison of genetic sequence-based method and flow cytometry assay. Reumatologia. 2015.

13. Seipp MT, Erali M, Wies RL, Wittwer C. HLA-B27 typing: Evaluation of an allele-specific PCR melting assay and two flow cytometric antigen assays. Cytom Part B - Clin Cytom. 2005;63(1):10–5.

14. Cho, E. H., Lee, S. G., Seok, J. H., Park, B. Y. N., & Lee, E. H. (2009). Evaluation of two commercial HLA-B27 Real-Time PCR kits. Annals of Laboratory Medicine, 29(6), 589–593. https://doi.org/10.3343/kjlm.2009.29.6.589

15. Asim M, Mathieu A, Sorrentino R, Akkoc N. The pathogenetic role of HLA-B27 and its subtypes. 2007;6:183–9.

16. Wang, H., Yang, C., Li, G., Wang, B., Qi, L., & Wang, Y. (2024). A review of long non-coding RNAs in ankylosing spondylitis: pathogenesis, clinical assessment, and therapeutic targets. Frontiers in Cell and Developmental Biology, 12. https://doi.org/10.3389/fcell.2024.1362476

17. Brown, M. A., Kenna, T., & Wordsworth, B. P. (2015). Genetics of ankylosing spondylitis—insights into pathogenesis. Nature Reviews Rheumatology, 12(2), 81–91. https://doi.org/10.1038/nrrheum.2015.133

18. Chang, C., Osoegawa, K., Milius, R. P., Maiers, M., Xiao, W., Fernandez-Viňa, M., & Mack, S. J. (2017). Collection and storage of HLA NGS genotyping data for the 17th International HLA and Immunogenetics Workshop. Human Immunology, 79(2), 77–86. https://doi.org/10.1016/j.humimm.2017.12.004

19. Dougados, M., & Baeten, D. (2011). Spondyloarthritis. The Lancet, 377(9783), 2127–2137. https://doi.org/10.1016/s0140-6736(11)60071-8

Downloads

Published

28-02-2026

How to Cite

Nora, R. L. D., Edwar, L., Susiyanti, M., Aziza, Y., Putera, I., Sifyana, U. A., Riasanti, M., Waliyuddin, M. Z., Wibawa, M. V., Ethelind, R., Widodo, E., & Sitompul, R. (2026). Affordable HLA-B27 Detection in Resource-Limited Settings: Evaluating Conventional PCR for Uveitis and Spondyloarthropathy in Indonesia. Ophthalmologica Indonesiana, 52(1), 20-26. https://doi.org/10.35749/oi.v52i1.102039
No Related Submission Found