Lower HLA-B27 positivity and heterogeneous late-onset case proportions across axial spondyloarthritis cohorts: a systematic review and meta-analysis.
Rheumatol IntSep 30, 2026 (epub)
Fei Yan, Ying Wang, Tianxing Wu et al.
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In 30 seconds
This systematic review and meta-analysis examined late-onset ankylosing spondylitis (AS) and axial spondyloarthritis (axSpA) in clinical cohorts, focusing on cases with onset at or after age 45. Among 6,631 patients, the pooled proportion of late-onset cases was 13.43%. The analysis revealed lower HLA-B27 positivity in later-onset cases, with an odds ratio of 0.47.
Key findings
- The pooled proportion of late-onset AS/axSpA cases was 13.43% (95% CI 9.23%-19.14%).
- Lower HLA-B27 positivity was associated with later onset, with an odds ratio of 0.47 (95% CI 0.34-0.67).
- High heterogeneity was observed in late-onset case proportions (I²=93.3%).
- Certainty of findings regarding male sex and radiographic features was very low.
Why it matters
Understanding the characteristics of late-onset AS/axSpA is crucial for accurate diagnosis and management. The association with lower HLA-B27 positivity may influence clinical decision-making and patient education regarding disease expectations.