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DOI: 10.5152/eurjrheum.2017.17044

ABO blood groups and rheumatic diseases 


Although various blood group systems have been described based on different blood group antigens, 

in clinical practice, the relevant blood group systems are ABO and Rhesus. The ABO blood group system 

consists of four basic groups, namely A, B, AB, and O, depending on the presence of the A and B antigens. 

These antigens are controlled by three allelic A, B, and O genes located on the long arm of chromosome 9 

(1). The blood groups in the Rhesus system are classified as Rh- and Rh+, depending on the presence of the 

Rhesus D antigen located on the red blood cell surface. Rh antigens are coded by three pairs of allele genes 

on chromosome 1. The major antigen of this group is Rho(D) (2). Although the entire human population 

shares similar ABO and Rh blood groups, the frequency and distribution of the blood groups vary among 

nationalities and races (3). The distribution of ABO blood groups worldwide is O>A>B>AB, whereas it is 

A>O>B>AB and Rh+>Rh- in Turkey (4-10).

The association of ABO and Rh blood groups with various diseases, such as cancer, cardiovascular disorders, 

infections, and diabetes mellitus, has been demonstrated (11-14). 

Our study aimed to determine whether there is an association between types of rheumatic diseases and 

the ABO and Rh blood groups.

Material and Methods 

The study included patients followed up at the Immunology-Rheumatology clinic in Aydın (Turkey) be-

tween January 2016 and December 2016 because of the diagnosis of a rheumatic disease and with ABO 

and Rh blood group data. Patient files were examined; age, gender, types of rheumatic diseases, and ABO 

Songül Çildağ, Yasemin Kara, Taşkın Şentürk

Original Article


Objective: Various genetic and environmental risk factors have been shown to be associated with the 

incidence of rheumatic diseases. However, the pathogenesis of rheumatic diseases poorly under-

stood. Several studies have shown associations of ABO blood groups with various diseases. Our study 

aimed to determine whether there is an association between the types of rheumatic diseases and 

ABO and Rh blood groups. 

Material and Methods: The study included the patients, followed up at the Immunology-Rheumatol-

ogy clinic between January 2016 and December 2016 for diagnosis of rheumatic disease, who had 

an ABO Rh blood data. Age, gender, type of rheumatic disease, ABO Rh blood groups were recorded. 

Results: When 823 patients were assessed for blood types, 42.5% patients had A type, 33.2% had O 

type, 15.4% had B type, and 8.9% had AB type. There was significant difference in the distribution of 

blood types in rheumatic diseases. While SpA, vasculitis, UCTD, Behçet’s and RA were more common 

in the patients with A blood type; FMF, SLE, SSc and SjS were more common in the patients with O 

blood type. In addition, the blood type where all the diseases are observed the least commonly was 

AB. There was significant difference in the distribution of Rh factor in rheumatic diseases. 92.2% pa-

tients were Rh positive and 7.8% patients were Rh negative. 

Conclusion: In our study, we thought that the higher incidence of different rheumatic diseases in 

different blood types was associated with different genetic predisposition.

Keywords: ABO blood group, rheumatic diseases, rh factor

Department of Immunology-

Rheumatology, Adnan Menderes 

University School of Medicine, Aydın, 


Address for Correspondence: 

Songül Çildağ, Department of 

Immunology-Rheumatology, Adnan 

Menderes University School of Medicine, 

Aydın, Turkey 


Submitted: 14 March 2017

Accepted: 6 June 2017

Available Online Date: 2 November 2017

©Copyright by 2017 Medical Research and 

Education Association - Available online at www.

Cite this article as: Çildağ S, Kara Y, 

Şentürk T. ABO blood groups and 

rheumatic diseases. Eur J Rheum 2017; 

DOI: 10.5152/eurjrheum.2017.17044

and Rh blood groups were recorded. For this 

retrospective study, approval was obtained 

from the Ethics Committee for Non-invasive 

Clinical Studies at the Adnan Menderes Uni-

versity School of Medicine (No: 2017/1061). 

As this study was retrospectively designed, 

there was no requirement of informed con-

sent forms.

Statistical evaluation: The Statistical Package 

for Social Science (SPSS) 18.0 software (IBM 

Corp.; Armonk, NY, USA) was used for the sta-

tistical evaluation of data. Data are presented 

as mean±standard derivation and percentage. 

The chi-square test was used for investigating 

the correlation between the types of rheumat-

ic diseases and blood groups. P-values of <0.05 

were considered statistically significant.


In the study, the mean age of the patients 

was 48.44±14.8 years; a total of 823 patients, 

including 581 (70.6%) female and 242 (29.4%) 

male patients, were examined. There were nine 

types of diseases, including spondyloarthrop-

athy (SpA), vasculitis, undifferentiated connec-

tive tissue disease (UCTD), Behçet’s diseases, 

familial Mediterranean fever (FMF), systemic 

lupus erythematosus (SLE), systemic sclerosis 

(SSc), Sjögren’s syndrome (SjS), and rheuma-

toid arthritis (RA). In total, 350 (42.5%) patients 

had blood group A type, 273 (33.2%) had O 

type, 127 (15.4%) had B type, and 73 (8.9%) 

had AB type. There was significant difference 

in the distribution of blood types in rheumatic 

diseases. While SpA, vasculitis, UCTD, Behçet’s 

disease, and RA were more common in the pa-

tients with the A blood type, FMF, SLE, SSc and 

SjS were more common in the patients with 

the O blood type. In addition, the blood type 

where all the diseases were observed the least 

commonly was AB blood type (Table 1). 

There was significant difference in the distribu-

tion of Rh factor in rheumatic diseases. In total, 

759 (92.2%) patients were Rh positive and 64 

(7.8%) patients were Rh negative (Table 2). 

In terms of the distribution by the ABO blood 

groups, the O blood type had SLE, SSc, and 

FMF at the highest rate; the A blood type had 

vasculitis, UCTD, RA, and SpA at the highest 

rate; the B blood type had Behçet’s disease and 

Çildag-    et al. Blood groups and rheumatic diseases

Eur J Rheumatol 2017

Table 2. Frequency of Rh factor in cases of rheumatic diseases 






Number Percent Number Percent Number Percent 



11  7.40  138  92.60 149  100 

χ2 p


1  3.00  32  97.00 33  100   


2  4.90  39  95.10 41  100 

Behçet’s disease 








4  7.40  50  92.60 54  100   


4  4.30  89  95.70 93  100

 47.38 .000


6  12.20 43  87.80 49  100   


3  6.00  47  94.00 50  100   


29  9.10  289  90.90 318  100   


64  7.80  759  92.20 823  100   

Rh: rhesus; SpA: spondyloarthropathy; UCTD: undifferentiated connective tissue disease; FMF: Familial Mediterranean fever; SLE: systemic lupus erythematosus; SSc: systemic sclerosis; SjS: Sjögren’s 

syndrome; RA: rheumatoid arthritis

Table 1. Frequency of ABO blood groups in cases of rheumatic diseases


n  O  A  B AB


Number Percent Number Percent Number Percent Number Percent Number Percent Significance


149 18.10 37 24.80 70 47.00 28 18.80 14  9.40 


33 4.00  9 27.30 19 57.60 2  6.10  3  9.10 


41  5.00  16 39.00 22 53.70 2  4.90  1  2.40


disease 36 4.40 10 27.80 12 33.30 9 25.00 5 13.90 



54 6.60 25 46.30 12 22.20 12 22.20 5  9.30 df=24


93 11.30 44 47.30 30 32.30 10 10.80  9  9.70 p=.000


49 6.00 23 46.90 14 28.60 8 16.30 4  8.20 


50 6.10 17 34.00 15 30.00 9 18.00 9 18.00 


318 38.60 92 28.90 156 49.10 47 14.80 23  7.20 


823  100  273 33.2 350 42.5 127 15.4  73  8.9 

SpA: spondyloarthropathy; UCTD: undifferentiated connective tissue disease; FMF: Familial Mediterranean fever; SLE: Systemic lupus erythematosus; SSc: systemic sclerosis; SjS: Sjögren’s syndrome; 

RA: rheumatoid arthritis

FMF at the highest rate; and the AB blood type 

had SjS at the highest rate (Figure 1).


In our study, the most common blood type in 

all the rheumatic diseases was A, followed by 

O, B, and AB. Our study does not have data for 

the normal population, and the distribution of 

blood types for the normal population in oth-

er studies conducted in Turkey is A>O>B>AB 

and Rh+>Rh- (5-10). Generally, the blood type 

distribution in rheumatic diseases appears to 

be the same as the normal population. Consid-

ering the type of rheumatic disease, the distri-

bution of blood groups for RA, SpA, vasculitis, 

UCTD, and Behçet’s disease is A>O>B>AB, 

which appears to be the same as that in the 

normal population. The most common blood 

type for FMF, SLE, SSc, and SjS is type O, fol-

lowed by A, B, and AB. Also, in our study, the 

rate of Rh factor positivity is higher in all the 

diseases groups. 

In the literature, studies investigating the as-

sociation of RA and ankylosing spondylitis (AS) 

with blood types are available, and similar to 

our study, the most common blood type in 

both diseases has shown to be A and the least 

common blood type has been shown to be AB 

(15, 16). In the literature, we found a study in-

vestigating the relationship between Behçet’s 

disease and blood types, wherein no signif-

icant difference with the control group was 

detected, and blood types O and A were found 

to be more common at similar rates (10). In a 

study of discoid lupus, blood type A was found 

to be at a higher rate, which was followed by 

blood types O, B Please use consistent font 

formats for column headings in Tables 1 and 2. 

Similarly, use uniform alignment for row head-

ings for the tables, and AB (17). In our study, 

all patients were followed up because of the 

diagnosis of SLE. In these patients, blood type 

O was positive at a higher rate, which was fol-

lowed by blood types A, B, and AB. 

In the literature, there were no studies inves-

tigating the association between SSc, SjS, and 

SLE and blood types. In our study, we found 

that the blood type O was the most common 

in all three groups of connective tissue disor-

ders, followed by blood types A, B, and AB. Fur-

ther, we did not find a study of FMF, an autoin-

flammatory disease, in the literature, and in our 

study, blood type A was found to be the most 

common in FMF patients. 

In our study, an interesting finding was that 

blood type A was found to be at the highest 

rate in patients with RA and AS with erosive ar-

thritis, which are the most common rheumatic 

diseases, and blood type O was found to be at 

the highest rate in patients with SLE, SSc, and 

SjS, which are among the connective tissue 

disorders frequently observed with antinucle-

ar antibodies. The reason for this could be the 

difference in the genetic characteristics of the 


Various genetic and environmental risk factors 

have been shown to be associated with the in-

cidence of rheumatic diseases (18, 19). Studies 

on genetic and environmental risk factors in 

rheumatic diseases have been conducted in 

patients with RA owing to its partially homoge-

neous disease phenotype and high prevalence 

(20). In major histocompatibility complex, the 

polymorphism of the three human leukocyte 

antigen (HLA) genes (HLA-DRB1, HLA-DP1, and 

HLA-B) is highly related to RA (21). As in RA and 

other autoimmune diseases, HLA genes are 

thought to have a central role in the predispo-

sition to SLE. HLA-DRB1*03:01 and *15:01 hap-

lotypes have been described as strong genetic 

risk factors for SLE in the European population 

(18). Different from other rheumatic diseases

the genetic relationship has been largely de-

scribed in AS patients, and the rate of HLA-B27 

positivity is known to be approximately 90% in 

these patients (22, 23). Although the genetic 

mechanism cannot be thoroughly explained 

in all patients, there is a strong relationship be-

tween Behçet’s disease and HLA-B51 (24).

It has been demonstrated that the genetic 

markers of autosomal recessive FMF are asso-

ciated with HLA-DR4 alleles and that HLA-DR 

levels increase during attacks compared to 

those in controls; studies have described the 

association between FMF and HLA-DR (25, 26). 

In SSc, some alleles on HLA-DRB1, DQB1, DPB1, 

and DPB2 have been shown to be risk factors 

for the disease (27-30). The association be-

tween HLA DR-2 and DR-3 has been described, 

and in subsequent studies of SjS, the haplo-

types DRB1* 0301 (HLA DR-3), DQB1 *0201, 

and DRB1*1501(DR-2) have been shown to be 

associated with the disease (31).

The strongest HLA association with antineutro-

phil cytoplasmic autoantibody-associated vas-

culitis has been shown to be with HLA DPB1 


The ABO blood groups are clinically practica-

ble parameters for performing genetic assess-

ments. In our study, we believe that the higher 

incidence of different rheumatic diseases in 

different blood types is associated with differ-

ent genetic predispositions.

Ethics Committee Approval: Ethics committee ap-

proval was received for this study from the ethics 

committee of Adnan Menderes University School of 

Medicine (No: 2017/1061).

Eur J Rheumatol 2017

Çildag-    et al. Blood groups and rheumatic diseases

Figure 1. Segregation of diseases according to ABO blood groups












0  A  B AB










Informed Consent:  As this study was retrospectively 

designed, there was no requirement of informed 

consent forms.

Peer-review: Externally peer-reviewed.

Author Contributions: Concept - S.Ç., T.Ş.; Design - S.Ç., 

Y.K., T.Ş.; Supervision - S.Ç., T.Ş.; Resources - S.Ç.; Ma-

terials - S.Ç.; Data Collection and/or Processing - S.Ç., 

Y.K., T.Ş.; Analysis and/or Interpretation - S.Ç., T.Ş.; Lit-

erature Search - S.Ç., Y.K.; Writing Manuscript - S.Ç., 

Y.K., T.Ş.; Critical Review - S.Ç., T.Ş.

Conflict of Interest: No conflict of interest was de-

clared by the authors.

Financial Disclosure: The authors declared that this 

study has received no financial support.


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