Which of the following is having a 90% associated with HLA B27
**Core Concept**
Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the axial skeleton, with a strong association between the disease and the human leukocyte antigen (HLA) B27 gene. This genetic predisposition plays a crucial role in the pathogenesis of AS.
**Why the Correct Answer is Right**
The presence of HLA-B27 is highly correlated with ankylosing spondylitis, with approximately 90% of patients testing positive for this allele. The HLA-B27 gene is involved in the immune system's ability to distinguish between self and non-self proteins. In AS, the presence of HLA-B27 leads to an abnormal immune response, resulting in inflammation and damage to the joints and surrounding tissues. This is thought to be mediated by the increased expression of pro-inflammatory cytokines and the activation of T-cells.
**Why Each Wrong Option is Incorrect**
**Option B:** Rheumatoid arthritis (RA) is a different autoimmune disease characterized by inflammation of the synovium, leading to joint damage and deformity. While RA has a genetic component, it is not strongly associated with HLA-B27. Instead, RA is associated with HLA-DRB1.
**Option C:** Psoriasis is a chronic skin condition characterized by inflammation and scaling. While there is some evidence of a genetic component to psoriasis, it is not strongly associated with HLA-B27.
**Option D:** Reiter's syndrome, also known as reactive arthritis, is a type of arthritis that occurs in response to an infection elsewhere in the body. While it shares some clinical features with AS, Reiter's syndrome is not strongly associated with HLA-B27.
**Clinical Pearl / High-Yield Fact**
It's essential to remember that the presence of HLA-B27 is not diagnostic for ankylosing spondylitis, as some individuals without AS may also test positive for this allele. However, the absence of HLA-B27 can help to rule out AS in patients with a low pre-test probability of the disease.
**✓ Correct Answer: A. Ankylosing spondylitis**