Background: MicroRNAs (miRNAs) are small non-coding single-stranded RNAs involved in the posttranscriptional inhibition of gene expression and thereby regulating all cellular functions. Their dysregulation contributes to the pathophysiology of many diseases, including rheumatic diseases. MiRNAs can also be found extracellularly in body fluids and represent promising diagnostic and prognostic biomarkers. Our study aimed to investigate miRNAs as biomarkers of stage and activity and predictors of therapeutic response of two most common inflammatory rheumatic diseases: spondyloarthritis (SpA) and rheumatic arthritis (RA). Results: We found several circulating miRNAs differentially expressed in SpA patients reflecting the severity of axial involvement and/or disease activity. The decrease in circulating miR-145 in plasma of patients with ankylosing spondylitis 3 months of anti-TNF therapy predicted a good therapeutic response and low disease activity after a year of therapy. Circulating and intracellular expression of miR-125b in peripheral blood mononuclear cells (PBMC) was lower in treatment-naïve patients with early RA than in healthy controls. Baseline expression of miR-125 in PBMC predicted a (non)adequate therapeutic response. We also found the increased expression of miR-451 in PBMC in...

Background: There is an unacceptable delay in diagnosis of axial Spondyloarthritis (axSpA) especially in its early stages among patients with inflammatory bowel disease (IBD). Objective: to develop a sensible and reliable questionnaire to identify undetected axSpA among IBD patients. Methods: Candidate items for the questionnaire were selected on 3 domains (IBD, inflammatory back symptoms, and extra-axial features). Sensibility of the Toronto axSpA Questionnaire (TASQ) was assessed leading to drafting 18 items. Test-retest reliability study was conducted among 77 patients with established IBD and axSpA and kappa agreement coefficients were calculated for items. Results: The TASQ was developed using multiple steps of sensibility assessment resulting in 16 items. Kappa coefficients ranged from 0.81 to 1.00 for all items indicating almost perfect agreement. Conclusion: TASQ is a newly developed, sensible and reliable questionnaire that should facilitate identification and referral of IBD patients to rheumatologists and should avoid delay in diagnosis of axSpA.

Background: There is an unacceptable delay in diagnosis of axial Spondyloarthritis (axSpA) especially in its early stages among patients with inflammatory bowel disease (IBD). Objective: to develop a sensible and reliable questionnaire to identify undetected axSpA among IBD patients. Methods: Candidate items for the questionnaire were selected on 3 domains (IBD, inflammatory back symptoms, and extra-axial features). Sensibility of the Toronto axSpA Questionnaire (TASQ) was assessed leading to drafting 18 items. Test-retest reliability study was conducted among 77 patients with established IBD and axSpA and kappa agreement coefficients were calculated for items. Results: The TASQ was developed using multiple steps of sensibility assessment resulting in 16 items. Kappa coefficients ranged from 0.81 to 1.00 for all items indicating almost perfect agreement. Conclusion: TASQ is a newly developed, sensible and reliable questionnaire that should facilitate identification and referral of IBD patients to rheumatologists and should avoid delay in diagnosis of axSpA.

Introduction: Axial spondyloarthritis (ax-SpA) is an inflammatory rheumatic disease. It is a unique model of bone remodeling disorders because, although one of the main diagnostic parameters is the rate of bone formation, inflammation present in patients' bodies increases the risk of pathological bone resorption, which can lead to osteoporosis. The processes of pathological resorption in ax-SpA have not been fully investigated, both in the disease as such and in the individual forms of the disease, i.e. non-radiographic (nr-axSpA), radiographic axial spondyloarthritis (r-axSpA) and ankylosing spondylitis (AS). This work deals with the influence of inflammatory serum of patients on the process of osteoclast differentiation from peripheral precursors of patients and healthy donors. Material and methods: Monocytes separated from the peripheral blood of either axSpA patients or healthy donors were stimulated for 14 days in vitro with serum from patients and in parallel with serum of age and sex of the corresponding healthy donors. Osteoclasts were evaluated as multinucleated, TRAP positive cells. Their numbers were statistically processed. Results: The inflammatory serum environment of patients with axSpA stimulated the osteoclastogenesis of axSpA monocytes significantly more (P <0,05) than the...

BACKGROUND: Distinguishing patients with axial spondyloarthritis (axial SpA) from patients with other causes of chronic back pain remains a challenge. The lack of reliable biomarkers contributes to the diagnostic delay in axial SpA. Recently, macrophage migration inhibitory factor (MIF) has been proposed as a candidate diagnostic and prognostic biomarker. MIF is a proinflammatory cytokine that was shown to be upregulated in several autoimmune diseases, including axial SpA. The putative role of CD8+ T cells in the disease process suggests further that serum markers of cytotoxicity might have value as serological biomarkers in axial SpA, and that subpopulations of cytotoxic lymphocytes might deserve attention as candidate cellular biomarkers. OBJECTIVE: The goal of this study was to compare serum levels of MIF and other candidate serum proteins in patients with axial SpA and controls, and to develop a flow cytometry panel to analyze cytotoxic lymphocyte cell subpopulations in these cohorts, including KIR+CD8+ T cells, Granzyme B+ CD8+ T cells, MAIT cells, and InEx cells. METHODS: Study subjects were recruited from the Brigham and Women’s Hospital Orthopedic and Arthritis Center. Four cohorts were compared: healthy controls (HC), patients with chronic low back pain (cLBP), axial SpA patients not on a biologic (axSpA/-), and axial SpA patients treated with a TNF inhibitor (axSpA/TNFi). Study subjects were matched for age, sex, and race, when possible. Serum was evaluated using the LEGENDplex Human CD8/NK panel (BioLegend) for thirteen markers including IL-17A, IL-6, TNF, granzyme B, and perforin. CRP and MIF were evaluated by DuoSet ELISA (R&D Systems). A high-dimensional flow cytometry panel was designed to evaluate 14 cell populations of interest. RESULTS: The severity of back pain in the cLBP controls and axSpA/- patients was comparable (BASDAI Q2 mean 5.0 +/- 1.9 vs. 5.0 +/- 3.0). axSpA/- patients had higher back pain, BASDAI and ASDAS scores than axSpA/TNFi patients consistent with higher disease activity in the biologic naïve group. Serum CRP values were significantly higher in axSpA/- patients compared with HC, cLBP controls, and axSpA/TNFi patients (P= 0.01, P=0.0029, P=0.004 respectively). Serum MIF levels were not statistically different between all four groups (P= 0.8069). Additionally, there were no statistically significant differences between the groups for any of the markers included in the LEGENDplex Human CD8/NK panel. A 32-color staining panel was developed to evaluate cytotoxic cell populations. CONCLUSION: In contrast to a previous study, we did not find differences in serum MIF levels between axial SpA patients and controls. Of the evaluated serum biomarkers, only CRP values correlated with active axial SpA. We have developed a promising flow cytometry panel that will help analyze subpopulations of cytotoxic cells. This ultimately could shed light on a candidate cellular biomarker. Our results underscore the need for more research into diagnostic biomarkers in axial SpA.

Individuals with rheumatic diseases such as Osteoarthritis (OA), Rheumatoid Arthritis (RA) and axial Spondyloarthritis (axSpA) usually are less physically active and engage in low-intensity training. Pain and function impairment lead to reduction in their quality of life. Evidence prove High-Intensity Training (HIT) can positively impact pain and function, however, usually neglected. Assessing the previous research and addressing knowledge gaps in this area can lead to more beneficial intervention to improve the overall quality of life among these populations. HIT is a beneficial and promising approach in most situations to managing symptoms including pain and function in individuals with OA, RA, and axSpA. However, contradictory results arise the need for further meticulous and high-quality studies in this area.

Background: Axial Spondyloarthritis (axSpA) is an autoimmune, chronic, rheumatic and inflammatory disease. In axSpA, the sacroiliac joint and the spine are affected, and common symptoms are stiffness and pain. For axSpA patients, systemic inflammation is a contributing factor to an increased risk of cardiovascular diseases (CVD). Calprotectin is a protein with multiple functions involved in the inflammatory response, and axSpA patients' calprotectin levels are elevated due to inflammation. Exercise is a non-pharmacological treatment, and for axSpA patients, it can reduce pain and increase mobility. The effects of High-intensity Interval Training (HIIT) have yet to be extensively researched in this patient group. Performing HIIT can increase maximal oxygen uptake (VO2max), reducing the risk of CVD. HIIT may also reduce inflammation, an essential factor in reducing the risk of CVD. Aim: The aim is to investigate how HIIT can affect calprotectin serum levels in axSpA patients and how calprotectin serum levels differ between healthy controls and axSpA patients. Method: Serum was collected before and after a HIIT bout from a cross-sectional pilot study, including axSpA patients (n=10) and healthy age- and sex-matched controls (n=11) and at baseline and after three months from a randomised control trial (RCT), which consisted of axSpA patients. The patients in the RCT were split into two groups: a control group (n=14) performing regular exercise and an intervention group (n=15) performing three HIIT sessions per week. Calprotectin in patients and healthy controls serum was analysed with a sandwich ELISA. Results: The comparison of serum calprotectin before and after a HIIT bout decreases in healthy controls (p=0.013) and indicates an increase of calprotectin in axSpA patients (p=0.059). After three months, the mean value of serum calprotectin in axSpA patients indicates a decrease in both the control and HIIT intervention groups. Conclusion: Our results suggest a trend towards regular HIIT, which can decrease serum calprotectin levels after three months. Therefore, HIIT could be considered a non-pharmacological treatment for axSpA patients. More studies with a larger axSpA population are necessary to investigate whether HIIT impacts serum calprotectin. / Bakgrund: Axial spondylartrit (axSpA) är en autoimmun, kronisk, reumatisk och inflammatorisk sjukdom. I axSpA påverkas sacroiliacaleden och ryggraden och vanliga symtom är stelhet och smärta. Patienter med axSpA har systemisk inflammation som är en bidragande faktor till ökad risk för hjärt-kärlsjukdomar (CVD). Kalprotektin är ett protein med flera funktioner som är involverat i den inflammatoriska responsen och hos patienter med axSpA är nivåerna av kalprotektin förhöjda på grund av inflammationen. Träning är en icke-farmakologisk behandling som kan minska smärta och öka rörlighet för axSpA patienter. Effekterna av högintensiv intervallträning (HIIT) har inte studerats i stor utsträckning i denna patientgrupp. Genom att utföra HIIT kan den maximala syreupptagningen (VO2max) förbättras, vilket kan minska risken för CVD. HIIT kan bidra till minskad inflammation, vilket kan minska risken för CVD. Syfte: Syftet är att undersöka hur HIIT kan påverka nivåerna av kalprotektin i serum hos patienter med axSpA och hur dessa nivåer skiljer sig mellan friska kontroller och patienter med axSpA. Metod: Serum har samlats in innan och efter ett HIIT pass från en tvärsnittsstudie och vid baseline och efter tre månader från en randomiserad kontrollstudie (RCT). Tvärsnittsstudien bestod av patienter med axSpA (n=10) samt friska ålders- och könsmatchade kontroller (n=11). RCTn bestod av patienter med axSpA som delades in i två grupper: en kontrollgrupp (n=14) som utförde regelbunden träning och en interventionsgrupp (n=15) som utförde tre HIIT-pass per vecka. Patienternas och de friska kontrollernas serum kalprotektin analyserades med en sandwich-ELISA. Resultat: Jämförandet av serum kalprotektin innan och efter ett HIIT pass hos friska kontroller visar en minskning av kalprotektin (p=0,013) och hos axSpA patienterna finns det en trend till en ökning av kalprotektin (p=0,059) efter HIIT-passet. Medelvärdet av serum kalprotektin hos axSpA patienter efter tre månader visar en tendens till en minskning i både kontroll- och HIIT-interventionsgruppen. Konklusion: Våra resultat indikerar att regelbunden HIIT efter tre månader kan minska nivåerna av serum kalprotektin. HIIT kan därför övervägas att vara en icke-farmakologisk behandling för axSpA patienter. Fler studier med en större axSpA population är nödvändigt för att vidare studera om HIIT påverkar serum kalprotektin.

Background: Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease affecting primarily the spine and its adjacent structures. The disease is characterized not only by destructive joint changes but also by excessive osteoproduction, which can lead to gradual ankylosis of the spine and thus significantly reduce the mobility and quality of life. The pathogenesis of the disease is not yet fully understood, but a strong genetic background is suggested, along with dysregulation of tissue metabolism resulting from an imbalance of pro- and anti-inflammatory immune mechanisms. We are still lacking biomarker with sufficient sensitivity and specificity which could help to identify early diagnosis, to monitor subchondral damage, and to differentiate rapidly progressing patients. The aim of this work was to determine the levels of potential biomarkers of connective tissue metabolism, fat metabolism and new promising biomarkers for both disease subtypes, their relationship to disease activity and progressive structural changes. Results: We have shown increased serum/plasma levels of connective tissue metabolism biomarkers (especially matrix metalloproteinase mediated metabolites), which were able to differentiate patients with early and late forms of axSpA from healthy individuals (HC), were...

Introdução: A Espondiloartrite axial (EpA-ax) é uma doença inflamatória e crônica do grupo das Espondiloartrites (EpA). Ela acomete o sistema músculo esquelético ocasionando inflamação das articulações axiais (especialmente da sacroilíaca). Quando essas manifestações são evidenciadas por exames de imagem, temos a caracterização da Espondilite Anquilosante (EA). Do contrário, chamamos de EpA-axial não radiográfica (EpA-ax-nr). A Espondilite Anquilosante (EA) se caracteriza pelo envolvimento inflamatório de articulações do esqueleto axial e apendicular. Seu diagnóstico é baseado em achados clínicos e radiológicos, além da elevação de marcadores inflamatórios e presença do HLA-B27. Várias são as metodologias que se propõem a identificar o HLA-B27 e a Polymerase Chain Reaction (PCR) é tida como referência. Sua ampla utilização esbarra, no entanto, em questões que levam em conta o custo, oferta do exame e o tempo até a obtenção do resultado. Neste contexto, a Citometria de Fluxo (CF) surge como uma alternativa capaz de ajudar o médico na identificação deste marcador genético que pode ser importante para o diagnóstico e prognóstico dessa doença. Objetivo: Avaliar a correlação entre as técnicas laboratoriais mais utilizadas na prática clínica (CF e PCR), comparando sensibilidade e especificidade para detecção do HLA-B27 em pacientes com diagnóstico estabelecido de EpA-ax. Métodos: Estudo transversal, comparativo, com pacientes maiores de 18 anos de idade selecionados por conveniência, coletados ao longo de 2015, com diagnóstico estabelecido de EpA-ax, segundo os do grupo internacional ASAS (working group - Assessment of SpondyloArthritis Intenational Society). Para a análise estatística o coeficiente Kappa (P<0,005 foi adotado como parâmetro. Para a análise estatística o coeficiente Kappa (P<0,005 foi adotado como parâmetro. O teste Exato de Fisher foi utilizado para comparar as variáveis categóricas, o teste t de Student, para variáveis quantitativas com distribuição simétrica de amostras independentes. E as variáveis com distribuição assimétrica foram comparadas pelo teste de Mann-Whitney. Resultados: O coeficiente Kappa obtido para a determinação da concordância entre os testes foi de 0,454. Foram incluídos no estudo 62 pacientes, desses, sessenta preencheram os critérios para diagnóstico de EA e 2 para EpA-ax não radiográfica (EpA-ax-nr), 64,5% dos pacientes eram do sexo masculino, 88,7% se autodeclararam brancos, a idade média (± desvio padrão) foi de 54,5±12 anos e o tempo mediano (percentis 25 e 75) de diagnóstico de 14 (9 e 24) anos. Dentre as características clínicas apresentadas pela população estudada houve diferença estatisticamente significativa para a artrite periférica, sendo mais frequente no grupo HLA-B27 negativo que no grupo HLA-B27 positivo (P=0,032). Na análise de correlação, 90,3% apresentaram tipagem HLA-B27 positiva por CF e 79,0% pela técnica de PCR. Tendo o PCR como padrão ouro, a CF apresentou uma sensibilidade de 98,0%, especificidade de 38,5% e uma acurácia de 85,5%. Conclusão: Apesar da baixa especificidade apresentada pela CF, nosso estudo demonstrou que a CF tem alta sensibilidade e boa acurácia o que a torna uma boa alternativa para ser utilizada como um teste de triagem na busca da caracterização da doença. Apesar da moderada concordância com a técnica de referência, a CF poderia ajudar o médico a excluir resultados falsamente negativos, racionalizando assim a investigação laboratorial para o diagnóstico da EA. / Introduction: Axial spondyloarthritis (SpA-ax) is an inflammatory and chronic disease of the Spondyloarthritis (SpA) group. It affects the skeletal muscle system causing inflammation of the axial joints (especially of the sacroiliac). When these manifestations are evidenced by imaging tests, a characterization of Ankylosing Spondylitis (AS). Otherwise, we call the non-radiographic SpA-axial (SpA-ax-nr). AS marked by the inflammatory involvement of the axial and appendicular skeletal joints. The diagnosis is based on clinical and radiological findings, as well as the on the elevation of inflammatory markers and presence of HLA-B27. There are several methodologies to identify the HLA-B27 gene and a Polymerase Chain Reaction (PCR) is considered the reference method. However, its use on a large scale does not progress because it takes into account the cost, offer of the exam and the running time to obtain the result. In this context, Flow Cytometry (FC) emerges as an alternative method, helping with the physician in the determination of this genetic marker, important for the diagnosis and prognosis of disease. Objective: To evaluate the correlation between FC and PCR, comparing sensitivity and specificity for detection of HLA-B27 in patients with established diagnosis of SpA-ax. Methods: A cross sectional study including 62 patients recruited during 2015 month was conducted in Hospital de Clínicas de Porto Alegre, an university public hospital. The sample, recruited by convenience in the SpA clinic, was composed of patients ≥ 18 years old, fulfilling the Assessment of Spondyloarthritis (ASAS) criteria SpA-ax. All participants underwent HLA-B27 typing through FC and PCR. The kappa statistic was used to calculate the concordance between the FC and PCR. Taking PCR as the gold standard, sensitivity and specificity of FC to detect HLA-B27 were calculated. Results: The Kappa coefficient obtained to determine the agreement between the tests was 0.454. Sixty two patients were included in the study, sixty met the criteria for diagnosis of AS and two for SpA-ax-nr, 64.5% of the patients were male, 88.7% were self-declared mean age (± standard deviation) was 54.5 ± 12 years and median time (25th and 75th percentiles) for diagnosis was 14 (9 and 24) years. Among the clinical characteristics presented by the population studied, there was a statistically significant difference for peripheral arthritis, wich was more frequent in the HLA-B27 negative group than in the HLA-B27 positive group (P = 0.032). In the correlation analysis, 90.3% presented HLA-B27 positive typing by FC and 79.0% by PCR technique. When PCR was considered the gold standard, CF had a sensitivity of 98.0%, specificity of 38.5% and an accuracy of 85.5%. Conclusion: Despite the low specificity presented by FC, our study demonstrated that FC has high sensitivity and good accuracy, which makes it a good alternative to be used as a screening test in the search for the characterization of the disease. Despite the moderate agreement with the reference technique, FC could help the physician to exclude falsely negative results, thus rationalizing laboratory investigation for the diagnosis of AS.

Introdução: A Espondiloartrite axial (EpA-ax) é uma doença inflamatória e crônica do grupo das Espondiloartrites (EpA). Ela acomete o sistema músculo esquelético ocasionando inflamação das articulações axiais (especialmente da sacroilíaca). Quando essas manifestações são evidenciadas por exames de imagem, temos a caracterização da Espondilite Anquilosante (EA). Do contrário, chamamos de EpA-axial não radiográfica (EpA-ax-nr). A Espondilite Anquilosante (EA) se caracteriza pelo envolvimento inflamatório de articulações do esqueleto axial e apendicular. Seu diagnóstico é baseado em achados clínicos e radiológicos, além da elevação de marcadores inflamatórios e presença do HLA-B27. Várias são as metodologias que se propõem a identificar o HLA-B27 e a Polymerase Chain Reaction (PCR) é tida como referência. Sua ampla utilização esbarra, no entanto, em questões que levam em conta o custo, oferta do exame e o tempo até a obtenção do resultado. Neste contexto, a Citometria de Fluxo (CF) surge como uma alternativa capaz de ajudar o médico na identificação deste marcador genético que pode ser importante para o diagnóstico e prognóstico dessa doença. Objetivo: Avaliar a correlação entre as técnicas laboratoriais mais utilizadas na prática clínica (CF e PCR), comparando sensibilidade e especificidade para detecção do HLA-B27 em pacientes com diagnóstico estabelecido de EpA-ax. Métodos: Estudo transversal, comparativo, com pacientes maiores de 18 anos de idade selecionados por conveniência, coletados ao longo de 2015, com diagnóstico estabelecido de EpA-ax, segundo os do grupo internacional ASAS (working group - Assessment of SpondyloArthritis Intenational Society). Para a análise estatística o coeficiente Kappa (P<0,005 foi adotado como parâmetro. Para a análise estatística o coeficiente Kappa (P<0,005 foi adotado como parâmetro. O teste Exato de Fisher foi utilizado para comparar as variáveis categóricas, o teste t de Student, para variáveis quantitativas com distribuição simétrica de amostras independentes. E as variáveis com distribuição assimétrica foram comparadas pelo teste de Mann-Whitney. Resultados: O coeficiente Kappa obtido para a determinação da concordância entre os testes foi de 0,454. Foram incluídos no estudo 62 pacientes, desses, sessenta preencheram os critérios para diagnóstico de EA e 2 para EpA-ax não radiográfica (EpA-ax-nr), 64,5% dos pacientes eram do sexo masculino, 88,7% se autodeclararam brancos, a idade média (± desvio padrão) foi de 54,5±12 anos e o tempo mediano (percentis 25 e 75) de diagnóstico de 14 (9 e 24) anos. Dentre as características clínicas apresentadas pela população estudada houve diferença estatisticamente significativa para a artrite periférica, sendo mais frequente no grupo HLA-B27 negativo que no grupo HLA-B27 positivo (P=0,032). Na análise de correlação, 90,3% apresentaram tipagem HLA-B27 positiva por CF e 79,0% pela técnica de PCR. Tendo o PCR como padrão ouro, a CF apresentou uma sensibilidade de 98,0%, especificidade de 38,5% e uma acurácia de 85,5%. Conclusão: Apesar da baixa especificidade apresentada pela CF, nosso estudo demonstrou que a CF tem alta sensibilidade e boa acurácia o que a torna uma boa alternativa para ser utilizada como um teste de triagem na busca da caracterização da doença. Apesar da moderada concordância com a técnica de referência, a CF poderia ajudar o médico a excluir resultados falsamente negativos, racionalizando assim a investigação laboratorial para o diagnóstico da EA. / Introduction: Axial spondyloarthritis (SpA-ax) is an inflammatory and chronic disease of the Spondyloarthritis (SpA) group. It affects the skeletal muscle system causing inflammation of the axial joints (especially of the sacroiliac). When these manifestations are evidenced by imaging tests, a characterization of Ankylosing Spondylitis (AS). Otherwise, we call the non-radiographic SpA-axial (SpA-ax-nr). AS marked by the inflammatory involvement of the axial and appendicular skeletal joints. The diagnosis is based on clinical and radiological findings, as well as the on the elevation of inflammatory markers and presence of HLA-B27. There are several methodologies to identify the HLA-B27 gene and a Polymerase Chain Reaction (PCR) is considered the reference method. However, its use on a large scale does not progress because it takes into account the cost, offer of the exam and the running time to obtain the result. In this context, Flow Cytometry (FC) emerges as an alternative method, helping with the physician in the determination of this genetic marker, important for the diagnosis and prognosis of disease. Objective: To evaluate the correlation between FC and PCR, comparing sensitivity and specificity for detection of HLA-B27 in patients with established diagnosis of SpA-ax. Methods: A cross sectional study including 62 patients recruited during 2015 month was conducted in Hospital de Clínicas de Porto Alegre, an university public hospital. The sample, recruited by convenience in the SpA clinic, was composed of patients ≥ 18 years old, fulfilling the Assessment of Spondyloarthritis (ASAS) criteria SpA-ax. All participants underwent HLA-B27 typing through FC and PCR. The kappa statistic was used to calculate the concordance between the FC and PCR. Taking PCR as the gold standard, sensitivity and specificity of FC to detect HLA-B27 were calculated. Results: The Kappa coefficient obtained to determine the agreement between the tests was 0.454. Sixty two patients were included in the study, sixty met the criteria for diagnosis of AS and two for SpA-ax-nr, 64.5% of the patients were male, 88.7% were self-declared mean age (± standard deviation) was 54.5 ± 12 years and median time (25th and 75th percentiles) for diagnosis was 14 (9 and 24) years. Among the clinical characteristics presented by the population studied, there was a statistically significant difference for peripheral arthritis, wich was more frequent in the HLA-B27 negative group than in the HLA-B27 positive group (P = 0.032). In the correlation analysis, 90.3% presented HLA-B27 positive typing by FC and 79.0% by PCR technique. When PCR was considered the gold standard, CF had a sensitivity of 98.0%, specificity of 38.5% and an accuracy of 85.5%. Conclusion: Despite the low specificity presented by FC, our study demonstrated that FC has high sensitivity and good accuracy, which makes it a good alternative to be used as a screening test in the search for the characterization of the disease. Despite the moderate agreement with the reference technique, FC could help the physician to exclude falsely negative results, thus rationalizing laboratory investigation for the diagnosis of AS.