HLA-B27

And so you can see that roughly 80% of the kids that are in our cohort met criteria for that enthesitis-related arthritis and about 5% met criteria for psoriatic arthritis.

And if you continue to look down the table, you can see slightly more than half of our kids were male, slightly less than half of the children were HLA-B27 positive, and around 10% had a family history of spinal arthritis.

So these are all pretty typical, I think, for what we would expect for a juvenile axial spa cohort and what's been published in the literature before.

Also, which is pretty notable, is just that when you look at our cohorts, Very few of these kids had polyarticular peripheral disease.

But then after twenty twenty-three, he was just under surveillance, um, and he was doing pretty well.

He also had a history of HLA-B27 related uveitis that is currently not active.

He denied any current red eyes or any, um, ophthalmology issues, and also a history of hypertension as well.

And as far as his medications, uh, for his transplant, so he was on prednisone five milligrams, tacrolimus point five milligrams twice a day.

She's like, "Oh, yeah, you're, you're a screaming case of Ehlers-Danlos." Um, she did the blood work, and she confirmed the inflammatory markers.

She did the genetic panel and also determined that I was positive for HLA-B27, and so that one was not on my radar.

That was something that she discovered for me, which I'm really grateful for, and that's ankylosing spondylitis, for folks that are unfamiliar.

And that's another genetic issue in which inflammation actually causes bony growth if, it- my body actually fuses bones and vertebrae together.

But I knew, like, I recognized the symptoms with her, so I took her to the pediatrician.

They did an X-ray.

They did her blood work, did her genetics, and they had said, "Hey, if she comes back positive for this HLA-B27 associated with the ankylosing spondylitis, it's an automatic referral to rheumatology." Hers came back positive for HLA-B27.

Her liver enzymes looked like mine had when they were inflamed.

And they actually have typical inflammatory back pain.

Some, uh, two of them know that they have something called ankylosing spondylitis with HLA-B27 that's positive, right? And the only thing that they need to take care of it is doing, uh, rock climbing, and they are incredibly, uh, good at rock climbing.

Uh, and so, you know- It's actually interesting is that they started rock climbing, they started seeing that they were feeling better with it, and so that's what they decided to do, so that's all they do.

They rock climb, and they know that they are gonna develop back pain if they stop.

And, uh, under the spondyloarthritis, there's many reason to have that.

So one of them is ankylosing spondylitis.

Usually, it can be HLA-B27, and it, uh, affects the low back, uh, very often.

It can affect also the chest.

And based on the back of that, I predicted, well, there's one group of chaps who never get AIDS, however much virus you give them, and that's the chimpanzee.

I reckon they must all be HLA-B27 or similar.

It took five years to persuade one of the people who had the last chimpanzee colony to do the HLA, the genetic immune code, and they were all HLA-B57, which is... sort of a brother of B27.

So absolutely right.

They treat a large part of the spine.

But the real issue is that actually both leukemia and ankylosing spondylitis are HLA-B27 associated.

So actually, it may well be that those patients were more likely to get leukaemia in the first place.

So all of those things mean actually maybe the whole thing was overstated.

And when I said the pain was most in the morning, he said, Go check your medical reports.

HLA-B27 will be positive.

Yes.

And I was shaking.

I was crying because HLA-B27 is a genetic blood disorder that you inherit from your ancestors.

You don't get it because of some mistake of yours or because you had a bad diet or because you ate junk or had a bad lifestyle.

It's something that you're born with and it triggers ankylosis spondylitis.

Well, the distinction comes down to the nature of the immune response.

Adult HLA-B27 associated uveitis is driven by an acute explosive cytokine storm.

That sudden inflammation causes intense ciliary muscle spasm, which is what generates the severe pain and photophobia.

Yeah.