The presence of both HLA-DRB1*04:01 and HLA-B*15:01 increases the susceptibility to cranial and extracranial giant cell arteritis

Abstract

Objective. To determine if patients with the predominant extracranial large-vessel vasculitis (LVV) pattern of giant cell arteritis (GCA) have a distinctive HLA-B association, different from that reported in biopsy-proven cranial GCA patients. In a further step we assessed if the combination of HLA-B and HLADRB1 alleles confers an increased risk for GCA susceptibility, both for the cranial and extracranial LVV phenotypes. Methods. A total of 184 patients with biopsy-proven cranial GCA, 105 with LVV-GCA and 486 healthy controls were included in our study. We compared HLA-B phenotype frequencies between the three groups. Results. HLA-B*15 phenotype was significantly increased in patients with classic cranial GCA compared to controls (14.7% vs. 5.8%, respectively; p<0.01; OR [95% CI]=2.81 [1.54-5.11]). It was mainly due to the HLA-B*15:01 allele (12.5% vs. 4.0%, respectively; p<0.01; OR [95% CI]=3.51 [1.77-6.99]) and remained statistically significant after Bonferroni correction. Similar HLA-B*15 association was observed in patients with the LVV-GCA (11.4% vs. 5.8%, p=0.04, OR [95% CI]=2.11 [1.04-4.30]). This association was also mainly due to the HLA-B*15:01 allele (10.5% vs. 4.0%, respectively; p=0.0054; OR [95% CI]=2.88 [1.19-6.59]). Noteworthy, the presence of HLA-B*15:01 together with HLA-DRB1*04:01 led to an increased risk of developing both cranial and extracranial LVV-GCA. Conclusion. Susceptibility to GCA is strongly related to the HLA region, regardless of the clinical phenotype of expression of the disease.