Session Information
Session Type: ACR Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose:
Inflammatory eye diseases such as scleritis and uveitis are associated with systemic autoimmune disease (SAD) and can be the initial manifestation of a concurrent or subsequent SAD. Despite this association, there remains no consensus on the initial diagnostic workup for patients without evidence of systemic involvement.
Methods:
We performed a retrospective review of patients seen at Cleveland Clinic between 2013 and 2014 by the ophthalmology department with a diagnosis of uveitis or scleritis based on ICD 9 and 10 codes. Subjects were included if they had recurrent or chronic uveitis or scleritis based on 2005 SUN working group nomenclature and no diagnosis of SAD prior to the inflammatory eye disease. Charts were further reviewed for any subsequent development of SAD. Sensitivity and specificity analysis was performed based on the following tests ANA, ACE, RF, CCP and ANCA and the associated SAD.
Results:
2351 patients were identified with uveitis or scleritis, of which 545 patients were recurrent or chronic and were included in the analysis. Eighty-five patients (15.6%) were subsequently diagnosed with a systemic autoimmune disease: sarcoidosis (54%), spondyloarthritis (22%), rheumatoid arthritis (13%), systemic lupus erythematous (7%), and anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (3.5%). Sensitivities of the screening tests are shown below.
|
screening test |
Number of unique patients with screening test ordered at least once (n=545) |
Number of patients diagnosed with SAD |
Sensitivity of serologies for diagnosis of SAD in patients with scleritis or uveitis (95% CI) |
|
ANA |
232 |
6 SLE |
* |
|
ACE |
262 |
46 Sarcoidosis |
0.59 (0.41-0.77) |
|
RF |
165 |
11 Rheumatoid Arthritis |
0.5 (0.19-0.81) |
|
CCP |
118 |
11 Rheumatoid Arthritis |
0.5 (0.19-0.81) |
|
HLA-B27 |
175 |
19 Spondyloarthritis |
0.55 (0.25-0.84) |
|
C-ANCA |
120 |
3 ANCA Vasculitis |
* |
|
P-ANCA |
120 |
3 ANCA Vasculitis |
* |
*Due to small sample size, sensitivity was not calculated.
Conclusion:
15% of patients diagnosed with chronic or recurrent autoimmune uveitis or scleritis subsequently developed a systemic autoimmune disease. Laboratory testing such as ANA for SLE, HLA-B27 for spondyloarthritis, RF and CCP for rheumatoid arthritis, C-ANCA and P-ANCA for ANCA associated vasculitis and ACE level for sarcoidosis were not sensitive for screening tests. Therefore, it is inadequate to use laboratory testing alone to guide referral for evaluation of systemic autoimmune disease in patients with chronic or recurrent uveitis or scleritis. Other aspects, such as characteristics of the eye findings and patient symptoms should be evaluated to improve sensitivity.
To cite this abstract in AMA style:
Wu A, Mapara S, Messner W, Srivastava S, Lowder C, Hajj-Ali RA. The Utility of Autoimmune Serologies in Recurrent and Chronic Inflammatory Eye Disease [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-utility-of-autoimmune-serologies-in-recurrent-and-chronic-inflammatory-eye-disease/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-utility-of-autoimmune-serologies-in-recurrent-and-chronic-inflammatory-eye-disease/