Suggested use of HLA-B27 testing.
| Specialty | Clinical Context | HLA-B27 Testing | Comments |
|---|---|---|---|
| General practitioner | Chronic back pain in patients aged < 45 years (especially with inflammatory features) | Yes | High pretest probability for axSpA May guide referral decision |
| Mechanical back pain | No | Low pretest probability | |
| Unexplained mono- or oligoarthritis in young patients | Consider | Only in the presence of other SpA features | |
| Rheumatologist | Diagnostic uncertainty in patients with several SpA features | Yes | Might increase diagnostic certainty |
| Confirmed axSpA/pSpA already meeting classification criteria | Optional | May provide prognostic value | |
| Ophthalmologist | Recurrent or severe AAU without known cause | Yes | Should prompt rheumatology refererral if positive |
| Dermatologist | Psoriasis with associated inflammatory musculoskeletal symptoms | Yes | May support diagnosis of psoriatic arthritis |
| Gastroenterologist | IBD with axial symptoms or peripheral arthritis | Yes | Should prompt rheumatology referral |
| All specialties | Rheumatologic screening (testing HLA-B27 with ANA, RF, anti-CCP) | No | HLA-B27 should be ordered only when clinically indicated |
AAU: acute anterior uveitis; ANA: antinuclear antibody; anti-CCP: anticyclic citrullinated peptide antibody; axSpA: axial spondyloarthritis; IBD: inflammatory bowel disease; pSpA: peripheral spondyloarthritis; RF: rheumatoid factor; SpA: spondyloarthritis.